Individual provider Active NPI

Christian Danielle Lyle, PAC

  • Physician Assistant
  • Savannah, GA
National Provider Identifier
1487241345
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10072 Issued in GA
Practice address
1139 Lexington Ave Ste a
Savannah, GA 31404-5502
Phone
(912) 303-4200
Fax
(912) 790-2701
NPI assigned
Dec 28, 2020
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10072 GA Primary

Addresses

Primary practice location

1139 Lexington Ave Ste a
Savannah, GA 31404-5502

Mailing address

1139 Lexington Ave Ste a
Savannah, GA 31404-5502
Phone (912) 303-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20210201000727 GA Practitioner - Physician Assistant 3274947320 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10072GAMDPharmacist

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1487241345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1139 LEXINGTON AVE STE A",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314045502",
            "telephone_number": "912-303-4200",
            "fax_number": "912-790-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 LEXINGTON AVE STE A",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314045502",
            "telephone_number": "912-303-4200",
            "fax_number": "912-790-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLE",
        "first_name": "CHRISTIAN",
        "middle_name": "DANIELLE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-28",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.