Lisa A Childress, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

15-01594 Issued in KS

Practice address

820 Ravenhill Dr
Suite 107
Atchison, KS 66002-9268

Phone

(913) 367-5496

Fax

(913) 674-2039

NPI assigned

Jun 18, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Shawnee Mission Medical Center Inc

  • Family Medicine Physician
  • Merriam, KS
  • NPI 1992735690
  Medicare reassignment
• Infinite Health Collaborative, PA

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1164474250
  NPD (past)

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361491200000",
    "number": "1659692176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 RAVENHILL DR",
            "address_2": "SUITE 107",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660029268",
            "telephone_number": "913-367-5496",
            "fax_number": "913-674-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 RAVENHILL DR",
            "address_2": "SUITE 107",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660029268",
            "telephone_number": "913-367-5496",
            "fax_number": "913-674-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-18",
        "last_updated": "2013-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "10735",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KS",
            "license": "15-01594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Cairo, LPN
• Wendy Marie Campbell, OTR/L
• Janette Carroll, CHW
• Jennifer D Cavin, LPC
• Margo Chartier
• Chirohealthcare, Chartered
• Leslie Ann Chorun, MD
• Jordan Clare, DPM
• Johnette Elisse Clark, PH.D.
• Michele Renee Combs

• Surgical Physician Assistant in Atchison, KS
• Providers in Atchison, KS by specialty
• Surgical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.