NPIMap

Individual provider Active NPI

Suzan Olivia Lisenby, MD

  • Physical Medicine & Rehabilitation Physician
  • Saint Joseph, MO
National Provider Identifier
1629572771
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2022033965 Issued in MO
Practice address
101 Mosaic CT Ste 300
Saint Joseph, MO 64506-0015
Phone
(816) 271-7673
Fax
(816) 271-4924
NPI assigned
Mar 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 11405437-1205 UT
Physical Medicine & Rehabilitation Physician 208100000X 2022033965 MO Primary

Addresses

Primary practice location

101 Mosaic CT Ste 300
Saint Joseph, MO 64506-0015

Mailing address

101 Mosaic CT Ste 300
Saint Joseph, MO 64506-0015
Phone (816) 271-7673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220913000802 MO Practitioner - Physical Medicine and Rehabilitation 6406289446 Reassigns benefits to 1 organization
I20260520001233 CO Practitioner - Physical Medicine and Rehabilitation 6406289446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Missouri, Kansas City, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Heartland Regional Medical CenterGroup PAC ID 6709772767, 394 clinicians

Practice addresses (Care Compare)

2500 Rocky Mountain Ave
Loveland, CO 80538-9004
Phone (970) 203-7142

5202 Faraon St
Suite a
Saint Joseph, MO 64506-3840
Phone (816) 271-1067

5301 Faraon St
Saint Joseph, MO 64506-3512
Phone (816) 271-7546

5301 Faraon St
Saint Joseph, MO 64506-3800

901 Heartland Rd
Saint Joseph, MO 64506-6201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.76 of 100Reported as group
Quality
74.35
Promoting interoperability
100
Improvement activities
40
Cost
74.85

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022033965MOMDPhysical Medicine & Rehabilitation Physician
11405437-1205UTMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Regional Medical Center Physical Medicine & Rehabilitation Current Accepting new patients
Heartland Regional Medical Center CurrentSince Sep 28, 2022 Accepting new patients
Heartland Regional Medical Center CurrentSince Sep 28, 2022 Accepting new patients

Locations

5301 Faraon St
Ste 200
Saint Joseph, MO 64506
Phone (816) 271-7573

5202 Faraon St
Ste A
Saint Joseph, MO 64506
Phone (816) 271-1070

5301 Faraon St
Ste 120
Saint Joseph, MO 64506
Phone (816) 271-6406

901 Heartland Rd
Ste 2800
Saint Joseph, MO 64506
Phone (816) 271-1213

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1629572771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MOSAIC CT STE 300",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645060015",
            "telephone_number": "816-271-7673",
            "fax_number": "816-271-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MOSAIC CT STE 300",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645060015",
            "telephone_number": "816-271-7673",
            "fax_number": "816-271-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISENBY",
        "first_name": "SUZAN",
        "middle_name": "OLIVIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "11405437-1205",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2022033965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

Verify at the official NPI Registry.