NPIMap

Individual provider Active NPI

Lisa Marie Antonio, MD

  • Family Medicine Physician
  • Sitka, AK
National Provider Identifier
1679951438
Registry record updated Oct 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
134059 Issued in AK
Practice address
222 Tongass Dr
Sitka, AK 99835
Phone
(907) 966-8318
Fax
(907) 966-8606
NPI assigned
May 13, 2015
Last updated
Oct 8, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MED-RES-LIC 52169 MT
Family Medicine Physician 207Q00000X 134059 AK Primary

Addresses

Primary practice location

222 Tongass Dr
Sitka, AK 99835

Mailing address

3100 Channel Dr Ste 300
Juneau, AK 99801-7837
Phone (907) 463-4074

Other practice location 1

123 S 27th St
Billings, MT 59101-4227
Phone (406) 247-3350

Other identifiers 1

IdentifierTypeStateIssuer
134059OtherAKSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181025000137 TX Practitioner - Family Practice 3072820760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New Mexico School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
134059AKMDFamily Medicine Physician
MED-RES-LIC 52169MTMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 17, 2018 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 17, 2018 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Interoperability endpoints

  • Direct secure messaging: lantonio@direct-searhc.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1679951438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 CHANNEL DR STE 300",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017837",
            "telephone_number": "907-463-4074",
            "fax_number": "907-463-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 TONGASS DR",
            "city": "SITKA",
            "state": "AK",
            "postal_code": "99835",
            "telephone_number": "907-966-8318",
            "fax_number": "907-966-8606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 S 27th St",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591014227",
            "country_code": "US",
            "telephone_number": "406-247-3350",
            "fax_number": "406-247-3389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTONIO",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-13",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MT",
            "license": "MED-RES-LIC 52169",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "134059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "134059",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sitka, AK

Sources for this page

Verify at the official NPI Registry.