Individual provider Active NPI

Ana Gabriela Lizama, M.D.

  • Neurology Physician
  • Manchester, NH
National Provider Identifier
1568699338
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
20887 Issued in NH
Practice address
185 Queen City Ave
Manchester, NH 03101-7121
Phone
(603) 663-4800
Fax
(603) 663-4805
NPI assigned
Jun 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 20887 NH Primary

Addresses

Primary practice location

185 Queen City Ave
Manchester, NH 03101-7121

Mailing address

185 Queen City Ave
Manchester, NH 03101-7121
Phone (603) 663-4800

Other practice location 1

280 Sierra College Dr
Suite 120
Grass Valley, CA 95945-5763
Phone (530) 477-4480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200226001288 CT Practitioner - Neurology 6901027770 Reassigns benefits to 1 organization
I20210109000078 NH Practitioner - Neurology 6901027770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

Practice addresses (Care Compare)

1 Elliot Way
Manchester, NH 03103-3502
Phone (603) 622-6484

185 Queen City Ave
Manchester, NH 03101-7121
Phone (603) 314-6900

One Elliot Way
100 Elliot Cardiovascular Consultants
Manchester, NH 03103-3502
Phone (603) 627-1669

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elliot Professional Services CurrentSince Dec 1, 2020 Accepting new patients
Middlesex Hospital CurrentSince Mar 23, 2020 Accepting new patients
Middlesex Hospital Neurology CurrentSince Mar 23, 2020 Accepting new patients

Locations

80 S Main St
Ste 102
Middletown, CT 06457
Phone (860) 358-6878

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

185 Queen City Ave
Unit 1
Manchester, NH 03101

1 Elliot Way
Manchester, NH 03103
Phone (603) 663-2271

185 Queen City Ave
Manchester, NH 03101
Phone (603) 314-6900

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1568699338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017121",
            "telephone_number": "603-663-4800",
            "fax_number": "603-663-4805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017121",
            "telephone_number": "603-663-4800",
            "fax_number": "603-663-4805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Sierra College Dr",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Grass Valley",
            "state": "CA",
            "postal_code": "959455763",
            "country_code": "US",
            "telephone_number": "530-477-4480",
            "fax_number": "530-274-7532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIZAMA",
        "first_name": "ANA",
        "middle_name": "GABRIELA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-18",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NH",
            "license": "20887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.