Individual provider Active NPI

Lisa K Walker, M.D.

  • Family Medicine Physician
  • Tacoma, WA
National Provider Identifier
1710955273
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60587860 Issued in WA
Practice address
1501 Pacific Ave
Tacoma, WA 98402-3302
Phone
(253) 680-6016
NPI assigned
Mar 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45580 CO
Family Medicine Physician 207Q00000X MD60587860 WA Primary

Addresses

Primary practice location

1501 Pacific Ave
Tacoma, WA 98402-3302

Mailing address

1501 Pacific Ave
Tacoma, WA 98402-3302
Phone (253) 680-6016

Other names 1

  • Lisa K Wagner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20151005003229 WA Practitioner - Family Practice 7012003510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

202 N Division St
Auburn, WA 98001-4939

220 15TH Ave SE
Suite C
Puyallup, WA 98372-3797
Phone (253) 848-6693

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

225 176TH St S
Spanaway, WA 98387-9201
Phone (253) 459-7777

311 S L St
Tacoma, WA 98405-3720

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

5700 100TH St SW
Suite 510
Lakewood, WA 98499-2767
Phone (253) 697-5200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45580COMDFamily Medicine Physician
MD60587860WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Family Medicine CurrentSince Oct 19, 2015 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Oct 19, 2015 Accepting new patients
KSB Medical Group, Inc. Family Medicine Past Accepting new patients
Multicare Health System Family Medicine Past Accepting new patients
KSB Medical Group, Inc. Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

4215 49th Ave NE
Tacoma, WA 98422
Phone (253) 459-7699

Organizations & group practices 6

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 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": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443052800000",
    "number": "1710955273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023302",
            "telephone_number": "253-680-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023302",
            "telephone_number": "253-680-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "LISA",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2015-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "45580",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60587860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "WAGNER",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.