NPIMap

Individual provider Active NPI

Benjamin Lisle, MD

  • Neurology Physician
  • Springfield, MO
National Provider Identifier
1598143505
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2020014928 Issued in MO
Practice address
3801 S National Ave # 900
Springfield, MO 65807-5210
Phone
(417) 875-3000
NPI assigned
May 11, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 2020014928 MO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3801 S National Ave # 900
Springfield, MO 65807-5210

Mailing address

PO Box 9007
Springfield, MO 65808-9007
Phone (417) 875-3000

Other practice location 1

17622 Crystal Valley Rd
Little Rock, AR 72210-3611
Phone (479) 200-2360

Other identifiers 1

IdentifierTypeStateIssuer
200084722MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20200730001609 MO Practitioner - Neurology 1951619766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lester E Cox Medical CentersGroup PAC ID 1254248917, 336 clinicians

Practice addresses (Care Compare)

3801 S National
Suite 900
Springfield, MO 65807-5210
Phone (417) 875-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.52 of 100Reported as group
Quality
61.64
Promoting interoperability
100
Improvement activities
40
Cost
76.77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020014928MOMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lester E Cox Medical Centers Current Accepting new patients
Lester E Cox Medical Centers Neurology CurrentSince Oct 1, 2022 Accepting new patients
Lester E Cox Medical Centers Past Accepting new patients
Lester E Cox Medical Centers Past Accepting new patients

Locations

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

1001 E Primrose St
Springfield, MO 65807
Phone (417) 875-3434

3801 S National Ave
#900
Springfield, MO 65807

1000 E Primrose St
Ste 360
Springfield, MO 65807
Phone (417) 269-4037

3800 S National Ave
Ste 400
Springfield, MO 65807
Phone (417) 269-9482

3801 S National Ave
Ste 900
Springfield, MO 65807
Phone (417) 269-2710

Organizations & group practices 4

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 7

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": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1598143505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658089007",
            "telephone_number": "417-875-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 S NATIONAL AVE # 900",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075210",
            "telephone_number": "417-875-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17622 Crystal Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722103611",
            "country_code": "US",
            "telephone_number": "479-200-2360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LISLE",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2020014928",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200084722",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.