Individual provider Active NPI

David Lisle, M.D.

  • Colon & Rectal Surgery Physician
  • Baltimore, MD
National Provider Identifier
1457645848
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
D83642 Issued in MD
Practice address
4832 Keswick Rd
Baltimore, MD 21210-2338
Phone
(202) 436-6139
NPI assigned
Jun 3, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Colon & Rectal Surgery Physician 208C00000X D83642 MD Primary

Addresses

Primary practice location

4832 Keswick Rd
Baltimore, MD 21210-2338

Mailing address

42 Bank St Apt 62
New York, NY 10014-5217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20171012002346 MD Practitioner - Colorectal Surgery (Proctology) 5991070278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Georgetown University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

12 Medstar Blvd
Bel Air, MD 21015-1798
Phone (410) 877-8088

1406 Crain S Hwy 106
Glen Burnie, MD 21061-4086
Phone (410) 768-6440

9000 Franklin Square Dr
Baltimore, MD 21237-3901
Phone (443) 777-7000

Hospital & facility affiliations

  • Medstar Health Home Care Home health agency, Baltimore, MD, CCN 217068
  • Medstar Franklin Square Medical Center Hospital, Rosedale, MD, CCN 210015

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy84
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D83642MDMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Mar 1, 2023 Accepting new patients
Medstar Medical Group II LLC Past Accepting new patients
Franklin Square Hospital Center, Inc Past Accepting new patients

Locations

12 Medstar Blvd
Ste 220
Bel Air, MD 21015
Phone (410) 877-8088

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

9000 Franklin Square Dr
Rosedale, MD 21237
Phone (410) 682-7000

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1457645848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 BANK ST APT 62",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100145217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4832 KESWICK RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212102338",
            "telephone_number": "202-436-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISLE",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-03",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MD",
            "license": "D83642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.