Active NPI
Lisa Marie Keovongsa, RD, LDN
- Registered Dietitian
- Arlington, MA
National Provider Identifier
1750859286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4706
- Practice address
- 30 Standish Rd
Arlington, MA 02476-7069 - Phone
- (781) 430-9833
- NPI assigned
- Nov 2, 2018
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4706 | MA | Primary |
Addresses
Primary practice location
30 Standish Rd
Arlington, MA 02476-7069
Mailing address
30 Standish Rd
Arlington, MA 02476-7069
Phone (781) 430-9833
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4706 | MA | MD | Corneal and Contact Management Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Actualize Counseling & Nutrition LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Arlington, MA
- NPI 1316571136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696550400000",
"number": "1750859286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 STANDISH RD",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024767069",
"telephone_number": "781-430-9833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 STANDISH RD",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024767069",
"telephone_number": "781-430-9833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOVONGSA",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-02",
"last_updated": "2023-10-06",
"certification_date": "2023-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "4706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.