Active NPI
Lisa Diane Fairweather, D.O.
- Psychiatry Physician
- Ft. Worth, TX
National Provider Identifier
1720031404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- L6256
- Practice address
- 5601 Bridge St.
#324
Ft. Worth, TX 76112 - Phone
- (817) 457-4646
- Fax
- (817) 492-7135
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | L6256 | TX | Primary |
Addresses
Primary practice location
5601 Bridge St.
#324
Ft. Worth, TX 76112
Mailing address
5601 Bridge St.
#324
Ft. Worth, TX 76112
Phone (817) 457-4646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175470702 | Medicaid | TX |
Other names 1
- Dr. Lisa Diane Alloju
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L6256 | TX | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milestone Geriatric Day Care, Inc | Past | Accepting new patients | |
| Milestone Geriatric Day Care, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Worth, TX
- NPI 1063447001
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Worth, TX
- NPI 1184671752
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287014400000",
"number": "1720031404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5601 BRIDGE ST.",
"address_2": "#324",
"city": "FT. WORTH",
"state": "TX",
"postal_code": "76112",
"telephone_number": "817-457-4646",
"fax_number": "817-492-7135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 BRIDGE ST.",
"address_2": "#324",
"city": "FT. WORTH",
"state": "TX",
"postal_code": "76112",
"telephone_number": "817-457-4646",
"fax_number": "817-492-7135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRWEATHER",
"first_name": "LISA",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2010-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "L6256",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175470702",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "ALLOJU",
"middle_name": "DIANE",
"prefix": "DR.",
"credential": "D.O.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ft. Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.