Active NPI
Lisa Thomas
- Specialist
- Eagle River, AK
National Provider Identifier
1629509468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 101539
- Practice address
- 11462 Business Blvd
Eagle River, AK 99577-7721 - Phone
- (907) 315-5482
- NPI assigned
- Mar 23, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 101539 | AK | Primary |
Addresses
Primary practice location
11462 Business Blvd
Eagle River, AK 99577-7721
Mailing address
11462 Business Blvd
Eagle River, AK 99577-7721
Phone (907) 315-5482
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 |
|---|---|---|---|
| 101539 | AK | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revive Aesthetics & Spa Wasilla, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Wasilla, AK
- NPI 1982237921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490227200000",
"number": "1629509468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11462 BUSINESS BLVD",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995777721",
"telephone_number": "907-315-5482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11462 BUSINESS BLVD",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995777721",
"telephone_number": "907-315-5482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-23",
"last_updated": "2017-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AK",
"license": "101539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.