Jack S Lissauer, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

35038212L Issued in OH

Practice address

3700 Park East Dr
Suite 100
Beachwood, OH 44122-4339

Phone

(216) 593-7700

Fax

(216) 593-7190

NPI assigned

Jul 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jlissauer32331@direct.ccf.org

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.

• Euclid Hospital Cleveland Clinic Health System

  • General Acute Care Hospital
  • Euclid, OH
  • NPI 1457403016
  NPD

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1720087356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 PARK EAST DR",
            "address_2": "SUITE 100",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224339",
            "telephone_number": "216-593-7700",
            "fax_number": "216-593-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 PARK EAST DR",
            "address_2": "SUITE 100",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224339",
            "telephone_number": "216-593-7700",
            "fax_number": "216-593-7190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISSAUER",
        "first_name": "JACK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35038212L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS & ANTHEM SR",
            "identifier": "000000127021",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONE NATION BENEFIT ADMIN.",
            "identifier": "000000127021",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5089882001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO OPERATING ENGINEERS",
            "identifier": "000000127021",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4079026",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "603650",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0307699",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD INSURANCE",
            "identifier": "P1482889",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APEX & SUMMACARE",
            "identifier": "R38212",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura D Lipold, MD
• Julie A Lipowski, RD, LD
• Alan J Lipsyc, R.PH., MBA
• Joan S Lipsyc
• Adrienne Lisan, LISW
• Little Sprouts Therapy LLC.
• Little Wings Counseling LLC
• Kelli M Littlejohn, DNP, FNP-C
• Svetlana Alana Litvak, CNP
• Richard Guy Litwin, PH.D.

• Gastroenterology Physician in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.