Individual provider Active NPI

Lisa Gaye Gill, CNP

  • Family Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1487658308
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-08068 Issued in OH
Practice address
2150 W Central Ave
Toledo, OH 43606-3834
Phone
(419) 291-8701
Fax
(419) 479-3298
NPI assigned
Jun 9, 2005
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-08068 OH Primary
Family Nurse Practitioner 363LF0000X 4704178651 MI

Addresses

Primary practice location

2150 W Central Ave
Toledo, OH 43606-3834

Mailing address

100 Madison Ave
Toledo, OH 43604-1516

Other identifiers 3

IdentifierTypeStateIssuer
NP08068OtherOHSTATE OHIO NP
2540843MedicaidOH
1487658308MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lgill24376@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050111000232 OH Practitioner - Nurse Practitioner 6204884802 Reassigns benefits to 2 organizations
I20101123000067 MI Practitioner - Nurse Practitioner 6204884802 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-1111

6869 S Occidental Rd
Tecumseh, MI 49286-9784
Phone (517) 423-4777

718 N Macomb St
Monroe, MI 48162-7815
Phone (419) 240-8835

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-08068OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Apr 14, 2011 Accepting new patients
Promedica Monroe Physicians CurrentSince Dec 1, 2018 Accepting new patients
Promedica Central Corporation of Michigan CurrentSince Mar 1, 2020 Accepting new patients
Promedica Central Physicians CurrentSince Apr 14, 2011 Accepting new patients
Kathryn E. Boehm, MD, LLC Past Accepting new patients
University of Toledo Physicians LLC Past Accepting new patients

Locations

3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

200 E Russell Rd
Unit C
Tecumseh, MI 49286
Phone (517) 424-3883

6711 Airport Hwy
Holland, OH 43528
Phone (567) 585-0070

3156 Dustin Rd
Ste 203
Oregon, OH 43616
Phone (419) 698-1514

1601 Brigham Dr
Ste 150
Perrysburg, OH 43551
Phone (419) 872-7246

900 W South Boundary St
Bldg 9A
Perrysburg, OH 43551
Phone (419) 872-3010

1 Seagate
Ste 800
Toledo, OH 43604

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2150 W Central Ave
Toledo, OH 43606
Phone (419) 291-2200

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1487658308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 W CENTRAL AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063834",
            "telephone_number": "419-291-8701",
            "fax_number": "419-479-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILL",
        "first_name": "LISA",
        "middle_name": "GAYE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP-08068",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704178651",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OHIO NP",
            "identifier": "NP08068",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2540843",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487658308",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lgill24376@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.