Active NPI
Lisa Marie Service, PA-C
- Medical Physician Assistant
- Miami Lakes, FL
National Provider Identifier
1598031015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9105791
- Practice address
- 15507 NW 67TH Ave
Miami Lakes, FL 33014-2108 - Phone
- (305) 821-8611
- Fax
- (305) 827-1753
- NPI assigned
- Mar 29, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 9105791 | FL | |
| Medical Physician Assistant | 363AM0700X | 9105791 | FL | Primary |
Addresses
Primary practice location
15507 NW 67TH Ave
Miami Lakes, FL 33014-2108
Mailing address
900 S Pine Island Rd
Plantation, FL 33324-3920
Phone (305) 821-8611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007661300 | Medicaid | FL |
Other names 1
- Lisa Marie Clarke
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9105791 | FL | MD | Community Health Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health of South Florida, Inc. | Past | Accepting new patients | |
| Saltzman, Tanis, Pittell, Levin and Jacobson | Past | Accepting new patients |
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.
-
- Federally Qualified Health Center (FQHC)
- Naranja, FL
- NPI 1023271855
-
dba Pediatric Associates
- Pediatrics Physician
- Hollywood, FL
- NPI 1639138480
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565913600000",
"number": "1598031015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 S PINE ISLAND RD",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333243920",
"telephone_number": "305-821-8611",
"fax_number": "305-827-1753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15507 NW 67TH AVE",
"city": "MIAMI LAKES",
"state": "FL",
"postal_code": "330142108",
"telephone_number": "305-821-8611",
"fax_number": "305-827-1753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERVICE",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-29",
"last_updated": "2019-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "9105791",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "9105791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007661300",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "CLARKE",
"middle_name": "MARIE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Miami Lakes, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.