Lisa Liane Dimodica, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA14335 Issued in CA

Practice address

47 Santa Rosa St
San Luis Obispo, CA 93405-5816

Phone

(805) 542-9596

NPI assigned

Dec 12, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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.

• Genesys Integrated Group Practice PC

  • Nurse Practitioner
  • Flint, MI
  • NPI 1386782381
  NPD (past)
• Quality Care Physicians Group

  • Emergency Medicine Physician
  • Waterford, MI
  • NPI 1114974912

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229040000000",
    "number": "1669617015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055816",
            "telephone_number": "805-542-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055816",
            "telephone_number": "805-542-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMODICA",
        "first_name": "LISA",
        "middle_name": "LIANE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-12",
        "last_updated": "2008-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA14335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Dieter, D.C.
• Dignity Community Care
• Denise Dillon
• Kristina Nelson Dilworth, RN, MS, FNP, ADM
• Michelle Lynn Dimmett
• Minhsang Jacqueline Dinh, DPT
• Robert B Dirksen, O.D.
• Tamra Ann Dison de Rivas
• William Dison
• Mary E. Ditomaso, LMFT

• Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.