Individual provider Active NPI

Elizabeth Ann Lonning, PSY D

  • Psychologist
  • Davenport, IA
National Provider Identifier
1568434603
Registry record updated Sep 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
00753 Issued in IA
Practice address
2102 E 38TH St
Davenport, IA 52807
Phone
(563) 359-4049
Fax
(563) 359-4069
NPI assigned
Feb 3, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 077005258 IL
Psychologist 103T00000X 00753 IA Primary

Addresses

Primary practice location

2102 E 38TH St
Davenport, IA 52807

Mailing address

2102 E 38TH St
Davenport, IA 52807
Phone (563) 359-4049

Other identifiers 1

IdentifierTypeStateIssuer
1108750000MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111013000290 IA Practitioner - Clinical Psychologist 9133391279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychology Health GroupGroup PAC ID 7810887452, 10 clinicians

Practice addresses (Care Compare)

2102 E 38TH St
Davenport, IA 52807-1135
Phone (563) 359-4049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
077005258ILMDPsychologist
00753IAMDOccupational Therapy Assistant

Organizations & group practices 1

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315958400000",
    "number": "1568434603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 E 38TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52807",
            "telephone_number": "563-359-4049",
            "fax_number": "563-359-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 E 38TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52807",
            "telephone_number": "563-359-4049",
            "fax_number": "563-359-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONNING",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2011-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "077005258",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "00753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1108750000",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.