NPIMap

Individual provider Active NPI

Bradley Alex Lisko, M.D.

  • Internal Medicine Physician
  • Westerville, OH
National Provider Identifier
1700889003
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
350633629L Issued in OH
Practice address
110 Polaris Pkwy
Ste 250
Westerville, OH 43082-8074
Phone
(614) 865-4800
Fax
(614) 865-4900
NPI assigned
May 31, 2005
Reactivated
Aug 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35063629L OH
Internal Medicine Physician 207R00000X 350633629L OH Primary

Addresses

Primary practice location

110 Polaris Pkwy
Ste 250
Westerville, OH 43082-8074

Mailing address

110 Polaris Pkwy
Ste 250
Westerville, OH 43082-8074

Other identifiers 1

IdentifierTypeStateIssuer
0154069MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bradleylisko@ppimp.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20111123000538 OH Practitioner - Internal Medicine 5193758019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio State University College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Ohio Primary Care Physicians, Inc.Group PAC ID 2769383785, 487 clinicians

Practice addresses (Care Compare)

655 Africa Rd
Westerville, OH 43082-9808
Phone (614) 865-3172

Hospital & facility affiliations

  • Summit Orthopaedic Home Care Home health agency, Grandview Heights, OH, CCN 368154
  • Capital Health Home Care Home health agency, Miamisburg, OH, CCN 368234
  • Mount Carmel Home Care Home health agency, Columbus, OH, CCN 367273
  • Grant Medical Center Hospital, Columbus, OH, CCN 360017
  • James Cancer Hospital & Solove Research Institute Hospital, Columbus, OH, CCN 360242
  • Riverside Methodist Hospital Hospital, Columbus, OH, CCN 360006
  • Ohio State University State Health System Hospital, Columbus, OH, CCN 360085
  • Grady Memorial Hospital Hospital, Delaware, OH, CCN 360210

Merit-based Incentive Payment System (MIPS)

Final score
87.04 of 100Reported as group
Quality
85.5
Improvement activities
40
Cost
83.38

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
350633629LOHMDInternal Medicine Physician
35063629LOHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients
Central Ohio Primary Care Physicians, Inc. Internal Medicine CurrentSince Mar 6, 2023 Accepting new patients
Central Ohio Primary Care Physicians, Inc. CurrentSince Mar 6, 2023 Accepting new patients
Ohio State University - Cap Internal Medicine PastSince Oct 1, 2021 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4885 Olentangy River Rd
Columbus, OH 43214
Phone (614) 326-5665

110 Polaris Pkwy
Ste 250
Westerville, OH 43082
Phone (614) 865-4800

655 Africa Rd
Westerville, OH 43082

Interoperability endpoints

  • Direct secure messaging: bradleylisko@ppimp.allscriptsdirect.net
  • Direct secure messaging: blisko18872@copcp.medicity.net

Organizations & group practices 5

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 11

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": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1700889003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 POLARIS PKWY",
            "address_2": "STE 250",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430828074",
            "fax_number": "614-865-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 POLARIS PKWY",
            "address_2": "STE 250",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430828074",
            "telephone_number": "614-865-4800",
            "fax_number": "614-865-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISKO",
        "first_name": "BRADLEY",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35063629L",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "350633629L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154069",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bradleylisko@ppimp.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "110 Polaris Pkwy",
            "address_2": "Ste 250",
            "city": "Westerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430828074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

Verify at the official NPI Registry.