NPIMap

Individual provider Active NPI

Lisa M Thorn, M.D.

  • Family Medicine Physician
  • Averill Park, NY
National Provider Identifier
1457432833
Registry record updated Jan 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
187244 Issued in NY
Practice address
3305 Route 43
Averill Park, NY 12018
Phone
(518) 674-5797
Fax
(518) 674-2396
NPI assigned
Oct 18, 2006
Last updated
Jan 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 187244 NY Primary

Addresses

Primary practice location

3305 Route 43
Averill Park, NY 12018

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 9

IdentifierTypeStateIssuer
10002042OtherNYCDPHP
383845OtherNYMVP
92949OtherNYGHI/HMO
01397479MedicaidNY
000401537006OtherNYBSNENY
FIDELISOtherNY070129000060
5562A1OtherNYEMPIRE BC
5731176OtherNYAETNA
SENIOR WHOLE HEALTHOtherNY200249

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050926001081 NY Practitioner - Family Practice 8820022395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albany Medical College of Union University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

711 Troy Schenectady Rd
Suite 203
Latham, NY 12110-2461
Phone (518) 782-3700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
187244NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Family Medicine CurrentSince Nov 1, 2017 Accepting new patients
Community Care Physicians, PC Past Accepting new patients
Community Care Physicians, PC Family Medicine Past Accepting new patients
Community Care Physicians, PLLC Family Medicine Past Accepting new patients
Beverwyck, Inc Past Accepting new patients

Locations

501 New Karner Rd
Ste 1A
Albany, NY 12205
Phone (518) 452-1337

20 Prospect St
Ste 106
Ballston Spa, NY 12020
Phone (518) 855-3755

6 Wellness Way
Ste 201
Latham, NY 12110
Phone (518) 782-3900

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

3732 Carman Rd
Schenectady, NY 12303
Phone (518) 356-4132

Interoperability endpoints

  • Direct secure messaging: lisathorn@ccp.allscriptsdirect.net
  • Direct secure messaging: lthornmd834710@direct.trinity-health.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eddy Village Green at BeverwyckSlingerlands, NY, CCN 335860 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 2, 2014
May 2, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Beverwyck, Inc

    dba Eddy Village Green at Beverwyck

    • Skilled Nursing Facility
    • Slingerlands, NY
    • NPI 1619282704

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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 7

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1457432833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 ROUTE 43",
            "city": "AVERILL PARK",
            "state": "NY",
            "postal_code": "12018",
            "telephone_number": "518-674-5797",
            "fax_number": "518-674-2396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORN",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "187244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10002042",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "383845",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/HMO",
            "identifier": "92949",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01397479",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000401537006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "070129000060",
            "identifier": "FIDELIS",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "5562A1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5731176",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "200249",
            "identifier": "SENIOR WHOLE HEALTH",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Averill Park, NY

Sources for this page

Verify at the official NPI Registry.