NPIMap

Individual provider Active NPI

Lisa Diane Reynolds

  • Family Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1396926945
Registry record updated Dec 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP117413 Issued in TX
Practice address
301 40TH St
Lubbock, TX 79404-2746
Phone
(806) 743-9355
Fax
(806) 743-9363
NPI assigned
Nov 23, 2007
Last updated
Dec 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 658247 TX
Family Nurse Practitioner 363LF0000X AP117413 TX Primary

Addresses

Primary practice location

301 40TH St
Lubbock, TX 79404-2746

Mailing address

301 40TH St
Lubbock, TX 79404-2746
Phone (806) 743-9355

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CombestWellness@direct.myteamcare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080114000276 TX Practitioner - Nurse Practitioner 2668552563 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

301 40TH St
Lubbock, TX 79404-2746
Phone (806) 743-9355

5202 82ND St
Lubbock, TX 79424-2823
Phone (806) 725-7337

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
658247TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center - Son - Lubbock CurrentSince Aug 1, 2016 Accepting new patients
Texas Tech University Health Sciences Center - Son - Lubbock Family CurrentSince Aug 1, 2016 Accepting new patients
Covenant Medical Group CurrentSince Dec 1, 2023 Accepting new patients
Covenant Medical Group CurrentSince Dec 1, 2023 Accepting new patients
Texas Tech University Health Sciences Center - Son - Lubbock Past Accepting new patients

Locations

1910 Quaker Ave
Ste 101
Lubbock, TX 79407
Phone (806) 725-4440

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

301 40th St
Lubbock, TX 79404
Phone (806) 743-9355

4515 Marsha Sharp Fwy
Lubbock, TX 79407
Phone 80674472232432

5202 82nd St
Lubbock, TX 79424
Phone (806) 701-5265

6501 University Ave
Ste 600
Lubbock, TX 79413
Phone (806) 743-2424

Interoperability endpoints

  • Direct secure messaging: lreynolds1@yourcarecommunity.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576281600000",
    "number": "1396926945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 40TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794042746",
            "telephone_number": "806-743-9355",
            "fax_number": "806-743-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 40TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794042746",
            "telephone_number": "806-743-9355",
            "fax_number": "806-743-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "LISA",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-23",
        "last_updated": "2019-12-14",
        "certification_date": "2019-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "658247",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP117413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CombestWellness@direct.myteamcare.com",
            "affiliation": "N",
            "endpointDescription": "Combest",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 40th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794042746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.