Lisa Pedevillano, DO

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

OS023186 Issued in PA

Practice address

9501 Roosevelt Blvd Ste 312
Philadelphia, PA 19114-1028

Phone

(215) 331-7001

Fax

(215) 331-7004

NPI assigned

Apr 29, 2016

Last updated

Oct 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Vascular Surgery

Education

Rowan University School of Osteopathic Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aria Health Physician ServicesGroup PAC ID 3577467018, 456 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Health- Northeast Hospital, Philadelphia, PA, CCN 390115
• Jefferson Abington Hospital Hospital, Abington, PA, CCN 390231

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Aria Health Physician Services

  dba Richboro Medical

  • Family Medicine Physician
  • Richboro, PA
  • NPI 1750949806
  Medicare reassignment Care Compare group NPD
• Aria Health Physician Services

  dba Geoffrey W. Temple Family Medical Associates

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1053181297
  NPD
• Aria Health Physician Services

  dba Aria Allmed Urgent Care Center Street Road

  • Surgery Physician
  • Bensalem, PA
  • NPI 1437537792
  NPD
• Aria Health Physician Services

  dba Aria Health Physician Services - Bucks Surgery

  • Surgery Physician
  • Langhorne, PA
  • NPI 1114981123
  NPD (past)
• Jefferson Health - Northeast

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1801963343
  NPD (past)

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

• Jefferson Health - Northeast

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1801963343
  Care Compare affiliation Name & address match
• Abington Memorial Hospital

  • General Acute Care Hospital
  • Abington, PA
  • NPI 1811992084
  Care Compare affiliation

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1720433535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606927",
            "telephone_number": "845-797-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 ROOSEVELT BLVD STE 312",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141028",
            "telephone_number": "215-331-7001",
            "fax_number": "215-331-7004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 W Sherman Ave",
            "address_purpose": "LOCATION",
            "city": "Vineland",
            "state": "NJ",
            "postal_code": "083606927",
            "country_code": "US",
            "telephone_number": "845-797-5195",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "240 Middletown Blvd Ste 101D",
            "address_purpose": "LOCATION",
            "city": "Langhorne",
            "state": "PA",
            "postal_code": "190471832",
            "country_code": "US",
            "telephone_number": "215-331-7001",
            "fax_number": "215-331-7004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDEVILLANO",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-29",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "OS023186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vijay Gopal Reddy Peddareddigari, MD
• Sreya Peddi
• Greg Pedegana, CRNA
• Heather M. Pederson, PH.D.
• Courtney Day Pederzani, PSY.D.
• Pediatric & Preventive Medicine Assoc PC
• Pediatric and Adolescent Medicine Group
• Pediatric Dental Assoc LTD
• Pediatric Dental Assoc LTD
• Pediatric Dental Assoc., LTD

• Vascular Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Vascular Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.