NPIMap

Individual provider Active NPI

Lisa Brooke Renfrow, APRN

  • Family Nurse Practitioner
  • Muskogee, OK
National Provider Identifier
1578003927
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0080011 Issued in OK
Practice address
2809 Circle Dr
Muskogee, OK 74403-6020
Phone
(918) 360-3794
NPI assigned
Mar 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X R0080011 OK
Family Nurse Practitioner 363LF0000X R0080011 OK Primary

Addresses

Primary practice location

2809 Circle Dr
Muskogee, OK 74403-6020

Mailing address

2809 Circle Dr
Muskogee, OK 74403-6020
Phone (918) 360-3794

Other names 1

  • Lisa Brooke Perkins Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171207000224 OK Practitioner - Nurse Practitioner 3779840350 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Health SystemGroup PAC ID 1456255025, 105 clinicians

Practice addresses (Care Compare)

1373 E Boone St
Tahlequah, OK 74464-3365

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

1500 E Downing St
Suite 103
Tahlequah, OK 74464-3354
Phone (918) 207-1410

205 Harris Cir
Tahlequah, OK 74464-8849
Phone (918) 456-0641

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0080011OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Health System CurrentSince Mar 14, 2018 Accepting new patients
Northeastern Health System Current Accepting new patients
Northeastern Health System CurrentSince Mar 14, 2018 Accepting new patients
Tahlequah Medical Group LLC CurrentSince Oct 1, 2017 Accepting new patients
Northeastern Health System Past Accepting new patients

Locations

1400 E Downing St
Tahlequah, OK 74464
Phone (918) 456-0641

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/932b43fb-c766-413c-a343-640549d20cb3/

Organizations & group practices 5

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 5

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": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501632000000",
    "number": "1578003927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 CIRCLE DR",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744036020",
            "telephone_number": "918-360-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 CIRCLE DR",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744036020",
            "telephone_number": "918-360-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENFROW",
        "first_name": "LISA",
        "middle_name": "BROOKE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2017-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": "R0080011",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0080011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "PERKINS",
            "middle_name": "BROOKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Muskogee, OK

Sources for this page

Verify at the official NPI Registry.