Individual provider Active NPI

Wesley Harris Lisker, M.D.

  • Nephrology Physician
  • Hayward, CA
National Provider Identifier
1619055472
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G42699 Issued in CA
Practice address
27303 Sleepy Hollow Ave S
Hayward, CA 94545-4203
Phone
(510) 454-1000
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X G42699 CA Primary

Addresses

Primary practice location

27303 Sleepy Hollow Ave S
Hayward, CA 94545-4203

Mailing address

27303 Sleepy Hollow Ave S
Hayward, CA 94545-4203
Phone (510) 454-1000

Other identifiers 1

IdentifierTypeStateIssuer
00G426990MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110210000000 CA Practitioner - NephrologyPractitioner - Internal Medicine 0941346233 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G42699CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Oct 20, 2010 Accepting new patients
Permanente Medical Group, Inc CurrentSince Oct 20, 2010 Accepting new patients

Locations

27303 Sleepy Hollow Ave S
Hayward, CA 94545
Phone (510) 454-1000

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1619055472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27303 SLEEPY HOLLOW AVE S",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945454203",
            "telephone_number": "510-454-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27303 SLEEPY HOLLOW AVE S",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945454203",
            "telephone_number": "510-454-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISKER",
        "first_name": "WESLEY",
        "middle_name": "HARRIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G42699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G426990",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "27303 Sleepy Hollow Ave S",
            "city": "Hayward",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945454203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hayward, CA

Sources for this page

Verify at the official NPI Registry.