Lisa Deette Staber, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38922 Issued in MN

Practice address

20635 Mishawaka Shores TRL
Grand Rapids, MN 55744-6071

Phone

(218) 398-0256

NPI assigned

Apr 27, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

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 2

Specialty

Family Practice

Education

Sanford School of Medicine of University of South Dakota, 1987

Medicare assignment

May accept Medicare assignment

Group practices

Avera Tyler 15 clinicians

Avera Granite Falls 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Avera Tyler Hospital Hospital, Tyler, MN, CCN 241348
• Avera Granite Falls Hospital, Granite Falls, MN, CCN 241343
• Avera Marshall Regional Medical Ctr Hospital, Marshall, MN, CCN 241359
• Avera Sunrise Manor Nursing home, Tyler, MN, CCN 245357

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.staber@avera.sdhealthlink.net

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.

• Avera Granite Falls

  • Critical Access Hospital
  • Granite Falls, MN
  • NPI 1700429610

  MN

  Medicare reassignment Care Compare group NPD
• Avera Tyler

  • Critical Access Hospital
  • Tyler, MN
  • NPI 1801840517

  MN

  Medicare reassignment Care Compare group NPD
• Avera Granite Falls

  • Family Medicine Physician
  • Granite Falls, MN
  • NPI 1700429644

  MN

  Medicare reassignment Care Compare group
• Avera Tyler

  • Rural Health Clinic/Center
  • Lake Benton, MN
  • NPI 1003869892
  Care Compare group NPD
• Avera Granite Falls

  • Medicare Defined Swing Bed Hospital Unit
  • Granite Falls, MN
  • NPI 1578106498
  Care Compare group
• Avera Granite Falls

  • Skilled Nursing Facility
  • Granite Falls, MN
  • NPI 1679116503
  Care Compare group
• Avera Tyler

  • Medicare Defined Swing Bed Hospital Unit
  • Tyler, MN
  • NPI 1326102237
  Care Compare group
• Avera Tyler

  • Rural Health Clinic/Center
  • Tyler, MN
  • NPI 1649223439
  Care Compare group
• Avera Tyler

  • Skilled Nursing Facility
  • Tyler, MN
  • NPI 1821042920
  Care Compare group
• Avera Tyler

  • Rural Health Clinic/Center
  • Ivanhoe, MN
  • NPI 1063949089
  NPD
• Northreach Healthcare, LLC

  • Family Medicine Physician
  • Daggett, MI
  • NPI 1033261623

  Family Medicine

  NPD (past)

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

• Avera Granite Falls

  • Critical Access Hospital
  • Granite Falls, MN
  • NPI 1700429610

  Hospital

  Care Compare affiliation
• Avera Marshall

  • Critical Access Hospital
  • Marshall, MN
  • NPI 1568401016

  Hospital

  Care Compare affiliation
• Avera Tyler

  • Critical Access Hospital
  • Tyler, MN
  • NPI 1801840517

  Hospital

  Care Compare affiliation
• Avera Tyler

  • Skilled Nursing Facility
  • Tyler, MN
  • NPI 1821042920

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1629035308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20635 MISHAWAKA SHORES TRL",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557446071",
            "telephone_number": "218-398-0256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20635 MISHAWAKA SHORES TRL",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557446071",
            "telephone_number": "218-398-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STABER",
        "first_name": "LISA",
        "middle_name": "DEETTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301086765",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38751-020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "38922",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38751-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4848740",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR-MEDICARE",
            "identifier": "P00328166",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR-MEDICARE",
            "identifier": "P00328166",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grand Rapids, MN
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; 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.