Active NPI
Patrice Lissade
- Dentist
- Cary, NC
National Provider Identifier
1497987861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037888
- Practice address
- 602 Prairie Meadows CT
Cary, NC 27519-6306 - Phone
- (919) 469-5050
- NPI assigned
- Aug 18, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS037888 | PA | Primary |
Addresses
Primary practice location
602 Prairie Meadows CT
Cary, NC 27519-6306
Mailing address
602 Prairie Meadows CT
Cary, NC 27519-6306
Phone (919) 469-5050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150522002463 | NC | Order and Referring Only - Dentist | 8921328402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9195 | NC | MD | Mental Health Counselor |
| DS037888 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250553600000",
"number": "1497987861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 PRAIRIE MEADOWS CT",
"city": "CARY",
"state": "NC",
"postal_code": "275196306",
"telephone_number": "919-469-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 PRAIRIE MEADOWS CT",
"city": "CARY",
"state": "NC",
"postal_code": "275196306",
"telephone_number": "919-469-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISSADE",
"first_name": "PATRICE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-18",
"last_updated": "2009-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.