Individual provider Active NPI

James E Lisle, DPM

  • Primary Podiatric Medicine Podiatrist
  • Salem, OR
National Provider Identifier
1740379387
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
130 Issued in OR
Practice address
3474 Liberty Rd S
Salem, OR 97302-4607
Phone
(503) 588-8188
Fax
(503) 588-0884
NPI assigned
Oct 12, 2006
Last updated
Aug 11, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 130 OR Primary

Addresses

Primary practice location

3474 Liberty Rd S
Salem, OR 97302-4607

Mailing address

3474 Liberty Rd S
Salem, OR 97302-4607
Phone (503) 588-8188

Other identifiers 1

IdentifierTypeStateIssuer
268243MedicaidOR

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

State licenses

LicenseStateTypeSpecialty
130ORMDPrimary Podiatric Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
James E. Lisle Primary Podiatric Medicine PastSince Sep 8, 1998 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1740379387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3474 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024607",
            "telephone_number": "503-588-8188",
            "fax_number": "503-588-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3474 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024607",
            "telephone_number": "503-588-8188",
            "fax_number": "503-588-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISLE",
        "first_name": "JAMES",
        "middle_name": "E",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "OR",
            "license": "130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268243",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.

Verify at the official NPI Registry.