Lisa Ingrid Nelson-Nguyen, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3415 53Rd Ave
Bettendorf, IA 52722-6976

Phone

(563) 742-4370

Fax

(309) 558-7026

NPI assigned

Sep 29, 2005

Reactivated

Apr 1, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 8

Other names 1

• Mrs. Lisa Ingrid Nelson Professional name

Medicare fee-for-service enrollment

Enrolled in IA, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Emory University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Rock Island Hospital, Rock Island, IL, CCN 140280

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: lnelsonnguyen159869@direct.unitypoint.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iowa Physicians Clinic Medical Foundation

  dba UnityPoint Clinic

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  IL

  Medicare reassignment Care Compare group NPD
• Iowa Physicians Clinic Medical Foundation

  dba Unitypoint Clinic Family Medicine - Correctionville

  • Rural Health Clinic/Center
  • Correctionville, IA
  • NPI 1639061583

  Physician Assistant

  NPD
• St Luke's Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Community Health Care, Inc.

  • Dental Clinic/Center
  • Davenport, IA
  • NPI 1598759029
  NPD (past)
• Community Health Care, Inc.

  dba CHC-Adult Rehabilitation Center

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1700866605
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1942280235
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1962496679
  NPD (past)
• Community Health Care, Inc.

  dba CHC-IL Homeless Drop In

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1093795981
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1598759292
  NPD (past)
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Moline, IL
  • NPI 1710971486
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Trinity Medical Center

  dba Trinity Rock Island

  • General Acute Care Hospital
  • Rock Island, IL
  • NPI 1316047632
  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1619964210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 53RD AVE",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527226976",
            "telephone_number": "563-742-4370",
            "fax_number": "309-558-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 53RD AVE",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527226976",
            "telephone_number": "563-742-4370",
            "fax_number": "309-558-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON-NGUYEN",
        "first_name": "LISA",
        "middle_name": "INGRID",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "deactivation_date": "2006-01-13",
        "reactivation_date": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "01283",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085001602",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "001283",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "079425",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING TAX ID# FOR CHC",
            "identifier": "421060724",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE EDI#",
            "identifier": "IA0184",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "P06822",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE #",
            "identifier": "5100541",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619964210",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0080200",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "42106072484",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "NELSON",
            "middle_name": "INGRID",
            "prefix": "MRS.",
            "credential": "PAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Near and Far Counseling PLLC
• James Nebinger, DC
• Anji A Neil, MD
• Nelson Chiropractic Systems, P.C. (Nelson Chiropractic)
• Traci N Nelson Johnson, DC
• Bethany Alicia Nelson, MS, CCC-SLP
• Jacob Thomas Nelson, PA-C
• Mercedez Nelson
• Richard Dean Nelson, D.D.S.
• Richard T Nelson, D.O.

• Physician Assistant in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.