Individual provider Active NPI

Lisa D Anderson, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Madison, MS
National Provider Identifier
1699703389
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
16045 Issued in MS
Practice address
935 Highway 51
Madison, MS 39110-8407
Phone
(601) 856-5986
NPI assigned
Jun 29, 2006
Last updated
Feb 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 16045 MS Primary

Addresses

Primary practice location

935 Highway 51
Madison, MS 39110-8407

Mailing address

308 Corporate Dr
Ridgeland, MS 39157-8803
Phone (601) 898-7500

Other identifiers 1

IdentifierTypeStateIssuer
00122742MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040831000306 MS Practitioner - General PracticePractitioner - Emergency Medicine 7810962107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quad Intermed Company LLCGroup PAC ID 6709245954, 42 clinicians

Practice addresses (Care Compare)

1265 Gluckstadt Rd
Suite B
Gluckstadt, MS 39110-7250
Phone (601) 859-8550

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16045MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Quad Intermed Company LLC CurrentSince Aug 1, 2023 Accepting new patients
Quad Intermed Company LLC CurrentSince May 11, 2025 Accepting new patients
Quad Intermed Company LLC CurrentSince Aug 1, 2023 Accepting new patients
Quad Intermed Company LLC Past Accepting new patients

Locations

1265 Gluckstadt Rd
Ste B
Gluckstadt, MS 39110
Phone (601) 859-8550

935 Highway 51
Madison, MS 39110
Phone (601) 856-5986

342 Gilchrist Dr
Pearl, MS 39208
Phone (601) 939-0700

308 Corporate Dr
Ridgeland, MS 39157
Phone (601) 898-7500

4204 Clay St
Vicksburg, MS 39183
Phone (601) 200-4560

4204 Clay St
#V
Vicksburg, MS 39183
Phone (601) 619-7717

307 E Fifteenth St
Yazoo City, MS 39194
Phone (662) 746-2113

Interoperability endpoints

  • Direct secure messaging: landerson2546074@direct.casso.us.com

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1699703389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 CORPORATE DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578803",
            "telephone_number": "601-898-7500",
            "fax_number": "601-898-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 HIGHWAY 51",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391108407",
            "telephone_number": "601-856-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "LISA",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MS",
            "license": "16045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122742",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.