Individual provider Active NPI

Lisa Pham Anthony, M.D.

  • Dermatology Physician
  • Rye, NY
National Provider Identifier
1407177553
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
279771 Issued in NY
Practice address
1 Theall Rd
Rye, NY 10580-1404
Phone
(914) 848-8840
Fax
(914) 848-8841
NPI assigned
Jun 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 279771 NY Primary

Addresses

Primary practice location

1 Theall Rd
Rye, NY 10580-1404

Mailing address

2700 Westchester Ave
Purchase, NY 10577-2547
Phone (914) 607-5730

Other practice location 1

5 E 98th St
Dermatology, 5th Floor
New York, NY 10029-6501
Phone (212) 241-9728

Other names 1

  • Dr. Lisa Pham Nguyen Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151008000822 NY Practitioner - Dermatology 0244457778 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Boston University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westchester Medical Group, P.CGroup PAC ID 6406752963, 410 clinicians

Practice addresses (Care Compare)

101 Theall Rd
Rye, NY 10580-1406
Phone (914) 925-8270

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision11
Removal of skin lesions492
Skin biopsy243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
279771NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Group, P.C. Dermatology CurrentSince Jul 1, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai Dermatology CurrentSince Sep 11, 2015 Accepting new patients
The Westchester Medical Group PC CurrentSince Jul 1, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 11, 2015 Accepting new patients

Locations

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

234 E 85th St
Fl 5
New York, NY 10028
Phone 2127313311 ext. 2

2700 Westchester Ave
Purchase, NY 10577
Phone (914) 607-5730

101 Theall Rd
Rye, NY 10580
Phone (516) 536-0800

1 Theall Rd
Rye, NY 10580
Phone (914) 848-8700

210 Westchester Ave
White Plains, NY 10604
Phone (914) 681-3100

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1407177553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 WESTCHESTER AVE",
            "city": "PURCHASE",
            "state": "NY",
            "postal_code": "105772547",
            "telephone_number": "914-607-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 THEALL RD",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105801404",
            "telephone_number": "914-848-8840",
            "fax_number": "914-848-8841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 E 98th St",
            "address_2": "Dermatology, 5th Floor",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296501",
            "country_code": "US",
            "telephone_number": "212-241-9728",
            "fax_number": "212-987-1197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTHONY",
        "first_name": "LISA",
        "middle_name": "PHAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-11",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "279771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "NGUYEN",
            "middle_name": "PHAM",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rye, NY

Sources for this page

Verify at the official NPI Registry.