NPIMap

Individual provider Active NPI

Lisa J Wasemiller-Smith, M.D.

  • Obstetrics & Gynecology Physician
  • Oklahoma City, OK
National Provider Identifier
1417954504
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD13137 Issued in OK
Practice address
11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone
(405) 936-1100
Fax
(405) 936-1122
NPI assigned
Jul 5, 2005
Reactivated
Mar 23, 2006
Last updated
May 15, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD13137 OK Primary

Addresses

Primary practice location

11200 N Portland Ave
Oklahoma City, OK 73120-5045

Mailing address

11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone (405) 936-1100

Other identifiers 2

IdentifierTypeStateIssuer
100824630AMedicaidOK
100824630CMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20101207001297 OK Practitioner - Obstetrics/Gynecology 4486849486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Oklahoma College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11200 N Portland
2ND FLR
Oklahoma City, OK 73120-5045
Phone (405) 936-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD13137OKMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lisa J Wasemiller-Smith MD Inc Obstetrics & Gynecology CurrentSince Jun 28, 2010 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

11200 N Portland Ave
Oklahoma City, OK 73120
Phone (405) 936-1000

11200 N Portland Ave
Fl 2
Oklahoma City, OK 73120
Phone (405) 936-1000

Organizations & group practices 3

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 8

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1417954504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205045",
            "telephone_number": "405-936-1100",
            "fax_number": "405-936-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205045",
            "telephone_number": "405-936-1100",
            "fax_number": "405-936-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASEMILLER-SMITH",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2008-05-15",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "MD13137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100824630A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100824630C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.