Individual provider Active NPI

Lisa S Gussak, M.D.

  • Family Medicine Physician
  • Worcester, MA
National Provider Identifier
1780667543
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
155167 Issued in MA
Practice address
26 Queen St
Family Practice 1
Worcester, MA 01610-2473
Phone
(508) 860-7700
Fax
(508) 860-7929
NPI assigned
Nov 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 155167 MA Primary

Addresses

Primary practice location

26 Queen St
Family Practice 1
Worcester, MA 01610-2473

Mailing address

26 Queen St
Family Practice 1
Worcester, MA 01610-2473
Phone (508) 860-7700

Other practice location 1

367 Plantation St
Worcester, MA 01605-2323
Phone (774) 442-4195

Other identifiers 1

IdentifierTypeStateIssuer
0109061MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20080313000551 MA Practitioner - Family Practice 1456436559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Connecticut School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
155167MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group Inc Family Medicine CurrentSince Nov 15, 2018 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Nov 15, 2018 Accepting new patients
Umass Memorial Medical Center, Inc. Past Accepting new patients

Locations

1 Innovation Dr
Worcester, MA 01605
Phone (508) 793-6100

26 Queen St
Worcester, MA 01610
Phone (508) 860-7700

367 Plantation St
Worcester, MA 01605
Phone (508) 334-1443

26 Queen St
Ste 1
Worcester, MA 01610
Phone (508) 860-7700

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: lgussak111552@umassmemorial.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1780667543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 QUEEN ST",
            "address_2": "FAMILY PRACTICE 1",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016102473",
            "telephone_number": "508-860-7700",
            "fax_number": "508-860-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 QUEEN ST",
            "address_2": "FAMILY PRACTICE 1",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016102473",
            "telephone_number": "508-860-7700",
            "fax_number": "508-860-7929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "367 Plantation St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016052323",
            "country_code": "US",
            "telephone_number": "774-442-4195",
            "fax_number": "508-334-1448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSSAK",
        "first_name": "LISA",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-25",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "155167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0109061",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.