Lisa Anne Ethridge

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

57020 Issued in NM

Practice address

1625 Rio Bravo Blvd SW Ste 36
Albuquerque, NM 87105-6060

Phone

(505) 777-3004

NPI assigned

Jul 22, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Vincent HospitalGroup PAC ID 6608775135, 335 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus St Vincent Regional Medical Center Hospital, Santa Fe, NM, CCN 320002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lethridge339586@christushealth.direct-ci.net

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.

• St Vincent Hospital

  • Pediatrics Physician
  • Santa Fe, NM
  • NPI 1063367803
  Medicare reassignment Care Compare group
• Newmexidoc, PA.

  • Urgent Care Clinic/Center
  • Santa Fe, NM
  • NPI 1316358989
  Medicare reassignment NPD
• Presbyterian Healthcare Services

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1104802354
  Medicare reassignment NPD
• Oak Street Health Physicians Group of New Mexico LLC

  • Primary Care Clinic/Center
  • Albuquerque, NM
  • NPI 1134793151

  Family

  NPD
• Presbyterian Healthcare Services

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470
  NPD
• St Vincent Hospital

  • General Acute Care Hospital
  • Santa Fe, NM
  • NPI 1578587150
  NPD
• St. Vincent Hospital

  • Family Medicine Physician
  • Santa Fe, NM
  • NPI 1235256447
  NPD
• St. Vincent Hospital

  • Family Medicine Physician
  • Santa Fe, NM
  • NPI 1245438647
  NPD
• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Vincent Hospital

  • General Acute Care Hospital
  • Santa Fe, NM
  • NPI 1578587150
  Care Compare affiliation

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1467005140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740018",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740018",
            "telephone_number": "773-759-7550",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 RIO BRAVO BLVD SW STE 36",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056060",
            "telephone_number": "505-777-3004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "328 Main St NE",
            "address_purpose": "LOCATION",
            "city": "Los Lunas",
            "state": "NM",
            "postal_code": "870317454",
            "country_code": "US",
            "telephone_number": "505-916-5446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "LISA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "57020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yahaira Estrada, LMSW- PROVISIONAL
• Aisha Estrella
• Coltilda Etcitty, RDH
• Eternal Light Counseling LLC
• Elizabeth M Etherton, CNP
• Jessica Etoll
• James Etre, OD
• Venus Etsitty, LPCC
• Shelley Euler-Beaudet, LPCC
• Bryan Lee Euler, PH.D.

• Family Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.