Lisa Ann Medvetz, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA06954000 Issued in NJ

Practice address

1113 Hospital Dr
Suite 100
Willingboro, NJ 08046-1103

Phone

(609) 835-5821

Fax

(609) 835-5827

NPI assigned

Jul 19, 2005

Last updated

Sep 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA, KY, WV, NH4 enrollments

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 4

Specialty

General Surgery

Education

Jefferson Medical College of Thomas Jefferson University, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grant Memorial Hospital IncGroup PAC ID 4183082712, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grant Memorial Hospital Hospital, Petersburg, WV, CCN 511316

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lmedvetz2852382@direct.trinity-health.org

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.

• Grant Memorial Hospital Inc

  • Critical Access Hospital
  • Petersburg, WV
  • NPI 1013603919
  Medicare reassignment Care Compare group NPD
• Androscoggin Valley Hospital Inc

  dba AVH Surgical Associates

  • General Practice Physician
  • Berlin, NH
  • NPI 1679526644

  Surgery

  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1922401611

  Surgery

  Medicare reassignment NPD
• Wayne Memorial Hospital

  • General Acute Care Hospital
  • Honesdale, PA
  • NPI 1124026182
  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  dba Dawson Springs Rural Health Clinic

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  NPD
• Grant Memorial Hospital Inc

  • Family Medicine Physician
  • Petersburg, WV
  • NPI 1679269583

  Surgery

  NPD
• Wayne Memorial Hospital

  • General Acute Care Hospital
  • Honesdale, PA
  • NPI 1649573023
  NPD
• Weeks Medical Center

  • Rural Health Clinic/Center
  • Whitefield, NH
  • NPI 1508819566
  NPD
• Grant Memorial Hospital

  • Critical Access Hospital
  • Petersburg, WV
  • NPI 1598763666
  NPD (past)
• Saint Alphonsus Specialty Services Inc

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1093040479
  NPD (past)
• Surgical Associates of Chester County

  • Surgery Physician
  • Coatesville, PA
  • NPI 1326035320
  NPD (past)

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

• Grant Memorial Hospital Inc

  • Critical Access Hospital
  • Petersburg, WV
  • NPI 1013603919
  Care Compare affiliation

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1467451823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 GROVE ST",
            "address_2": "SUITE 100",
            "city": "HADDON HEIGHTS",
            "state": "NJ",
            "postal_code": "080351761",
            "telephone_number": "856-796-9200",
            "fax_number": "856-796-9397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 HOSPITAL DR",
            "address_2": "SUITE 100",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080461103",
            "telephone_number": "609-835-5821",
            "fax_number": "609-835-5827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Maple Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Honesdale",
            "state": "PA",
            "postal_code": "184311436",
            "country_code": "US",
            "telephone_number": "570-253-8635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "999 N Curtis Rd Ste 415",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837061334",
            "country_code": "US",
            "telephone_number": "208-302-2600",
            "fax_number": "208-302-2625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDVETZ",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "PA",
            "license": "MD060721-L",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "51460",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD060721L",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M-13032",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA06954000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "113499",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017932090008",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8239606",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pravinkumar K Mashru II
• Brenda Mayo-Ekuma, LPN
• Victoria McCoy, LPN
• Medco Health Solutions of Willingboro, LLC (Medco Center for Pharmacotherapeutic Research)
• Medexpress Urgent Care - New Jersey, Inc. (MedExpress Urgent Care - Willingboro)
• Meek & Humble LLC
• Shivalika Mehan, MD
• Jasmeet Mehta, M.D
• Vittoria Mello, FNP-BC
• Dela-Dem Mensah

• Surgery Physician in Willingboro, NJ
• Providers in Willingboro, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.