Active NPI
Lisa Paige Reddan, MS RD CDE
- Registered Dietitian
- Bozeman, MT
National Provider Identifier
1417285313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 670839
- Practice address
- 703 S Grand Ave
Bozeman, MT 59715-5221 - Phone
- (406) 582-0357
- Fax
- (406) 582-5481
- NPI assigned
- Dec 3, 2009
- Last updated
- Dec 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 670839 | CA | Primary |
Addresses
Primary practice location
703 S Grand Ave
Bozeman, MT 59715-5221
Mailing address
703 S Grand Ave
Bozeman, MT 59715-5221
Phone (406) 582-0357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130222000237 | MT | Practitioner - Registered Dietitian Or Nutrition Professional | 9830344803 | Practice locations: Bozeman, MT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 670839 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transforming Nutrition Care | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1417285313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 S GRAND AVE",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597155221",
"telephone_number": "406-582-0357",
"fax_number": "406-582-5481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 S GRAND AVE",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597155221",
"telephone_number": "406-582-0357",
"fax_number": "406-582-5481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDAN",
"first_name": "LISA",
"middle_name": "PAIGE",
"credential": "MS RD CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-03",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "670839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.