Individual provider Active NPI

Lisa Elizabeth Bragg, AU.D.

  • Audiologist
  • Ellicott City, MD
National Provider Identifier
1548523228
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
01253 Issued in MD
Practice address
3290 N Ridge Road Suite 125
Ellicott City, MD 21043-6017
Phone
(410) 696-2890
Fax
(410) 696-2886
NPI assigned
Jun 19, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 01253 MD Primary

Addresses

Primary practice location

3290 N Ridge Road Suite 125
Ellicott City, MD 21043-6017

Mailing address

3290 N Ridge Road Suite 125
Ellicott City, MD 21043-3656
Phone (410) 696-2890

Other names 1

  • Lisa Elizabeth Dau Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120831000616 MD Practitioner - Qualified Audiologist 6709033418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarity Audiology and Hearing Solutions, LLCGroup PAC ID 5890978845, 4 clinicians

Practice addresses (Care Compare)

3290 N Ridge Rd
Suite 125
Ellicott City, MD 21043-3656
Phone (410) 696-2890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
01253MDMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarity Audiology & Hearing Solutions, LLC CurrentSince Aug 17, 2015 Accepting new patients
Hearing Assessment Center, Inc. Audiologist Past Accepting new patients

Locations

1380 Progress Way
Ste 109
Eldersburg, MD 21784
Phone (410) 549-9780

3290 North Ridge Rd
Ste 125
Ellicott City, MD 21043
Phone (410) 465-1080

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521158400000",
    "number": "1548523228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3290 N RIDGE ROAD SUITE 125",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433656",
            "telephone_number": "410-696-2890",
            "fax_number": "410-696-2886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 N RIDGE ROAD SUITE 125",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436017",
            "telephone_number": "410-696-2890",
            "fax_number": "410-696-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAGG",
        "first_name": "LISA",
        "middle_name": "ELIZABETH",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2018-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MD",
            "license": "01253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "DAU",
            "middle_name": "ELIZABETH",
            "credential": "AU.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.