Lisa Anne Mucciolo, MD

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

MD067434L Issued in PA

Practice address

80 Medical Park Dr
Lewisburg, PA 17837-6343

Phone

(570) 768-4646

Fax

(570) 768-4648

NPI assigned

Aug 19, 2005

Sex

Female

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 1

Other names 1

• Ms. Lisa Anne Licata Other name

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

Rheumatology

Education

Georgetown University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Evangelical Medical Services OrganizationGroup PAC ID 9133033087, 255 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellspan Evangelical Community Hospital Hospital, Lewisburg, PA, CCN 390013
• Geisinger Medical Center Hospital, Danville, PA, CCN 390006
• Geisinger-Bloomsburg Hospital Hospital, Bloomsburg, PA, CCN 390003

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lmucciolo485077@wellspan.direct-ci.com

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.

• Evangelical Medical Services Organization

  • Surgery Physician
  • Lewisburg, PA
  • NPI 1205928967

  Rheumatology

  Medicare reassignment Care Compare group NPD
• Wellspan Medical Group

  • Gastroenterology Physician
  • York, PA
  • NPI 1669770004
  Medicare reassignment Care Compare group NPD
• Evangelical Medical Services Organization

  • Urology Physician
  • Lewisburg, PA
  • NPI 1083412084
  NPD
• Wellspan Medical Group

  • Pediatric Surgery Physician
  • York, PA
  • NPI 1104799428
  NPD
• Wellspan Medical Group

  • Rheumatology Physician
  • York, PA
  • NPI 1407916018
  NPD
• Wellspan Medical Group

  • Family Medicine Physician
  • York, PA
  • NPI 1598862716
  NPD (past)

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

• Evangelical Community Hospital

  • General Acute Care Hospital
  • Lewisburg, PA
  • NPI 1124076039
  Care Compare affiliation
• Geisinger Bloomsburg Hospital

  • General Acute Care Hospital
  • Bloomsburg, PA
  • NPI 1629688429
  Care Compare affiliation
• Geisinger Bloomsburg Hospital

  • General Acute Care Hospital
  • Bloomsburg, PA
  • NPI 1821198755
  Care Compare affiliation
• Geisinger Medical Center

  • Clinic/Center
  • Pottsville, PA
  • NPI 1003170937

  Hospital

  Care Compare affiliation
• Geisinger Medical Center

  • General Acute Care Hospital
  • Danville, PA
  • NPI 1013384809
  Care Compare affiliation
• Geisinger Medical Center

  • General Acute Care Hospital
  • Coal Township, PA
  • NPI 1033491741
  Care Compare affiliation
• Geisinger Medical Center

  • Clinic/Center
  • Shamokin, PA
  • NPI 1063708501

  Hospital

  Care Compare affiliation
• Geisinger Medical Center

  • Clinic/Center
  • Danville, PA
  • NPI 1093555120

  Hospital

  Care Compare affiliation
• Geisinger Medical Center

  • Clinic/Center
  • Danville, PA
  • NPI 1104682061

  Hospital

  Care Compare affiliation
• Geisinger Medical Center

  • Psychiatric Hospital Unit
  • Danville, PA
  • NPI 1144301102
  Care Compare affiliation
• Geisinger Medical Center

  • General Acute Care Hospital
  • Lewisburg, PA
  • NPI 1154617694
  Care Compare affiliation
• Geisinger Medical Center

  • General Acute Care Hospital
  • Danville, PA
  • NPI 1235215427
  Care Compare affiliation

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1770575219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR STE 306",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-522-4110",
            "fax_number": "570-768-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MEDICAL PARK DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178376343",
            "telephone_number": "570-768-4646",
            "fax_number": "570-768-4648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUCCIOLO",
        "first_name": "LISA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "PA",
            "license": "MD067434L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017494250005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "LICATA",
            "middle_name": "ANNE",
            "prefix": "MS.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Emily E Mowry, CPNP
• Thomas E. Mowry, CRNA
• Alexander P. Moya, M.D.
• Brandy Lee Moyer, PA-C
• Joseph M Mucciolo Jr., MD
• Angela Rebecca Muchler, AU.D.
• Anna Rachael Muench, DDS,MS
• Eustacia S Muir, NP
• Janice Muldowney, OTR/L
• Grace Di Mullen

• Rheumatology Physician in Lewisburg, PA
• Providers in Lewisburg, PA by specialty
• Rheumatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.