Individual provider Active NPI

Lisa M. Kilpela, PHD

  • Clinical Psychologist
  • San Antonio, TX
National Provider Identifier
1457709396
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
37210 Issued in TX
Practice address
4502 Medical Dr
San Antonio, TX 78229-4402
Phone
(210) 450-6440
Fax
(210) 450-2104
NPI assigned
Jun 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 37210 TX Primary

Addresses

Primary practice location

4502 Medical Dr
San Antonio, TX 78229-4402

Mailing address

7703 Floyd Curl Dr
San Antonio, TX 78229-3901
Phone (210) 450-6440

Other identifiers 1

IdentifierTypeStateIssuer
358280102MedicaidTX

Other names 1

  • Lisa M. Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160621000102 TX Practitioner - Clinical Psychologist 2264723337 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37210TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at San Antonio Current Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince May 4, 2016 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince May 4, 2016 Accepting new patients

Locations

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

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.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468800000000",
    "number": "1457709396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293901",
            "telephone_number": "210-450-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 MEDICAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294402",
            "telephone_number": "210-450-6440",
            "fax_number": "210-450-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILPELA",
        "first_name": "LISA",
        "middle_name": "M.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "358280102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SMITH",
            "middle_name": "M.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.