Individual provider Active NPI

Lisa K. Harrison, RN, CCRN, AGACNP-BC

  • Nurse Practitioner
  • Scottsdale, AZ
National Provider Identifier
1790105567
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
234142 Issued in AZ
Practice address
15333 N Pima Rd Ste 305
Scottsdale, AZ 85260-2717
Phone
(866) 949-0108
NPI assigned
Apr 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024171479 VA
Nurse Practitioner 363L00000X 234142 AZ Primary

Addresses

Primary practice location

15333 N Pima Rd Ste 305
Scottsdale, AZ 85260-2717

Mailing address

40 S Main St Ste 1300
Memphis, TN 38103-5513
Phone (866) 949-0108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260416002587 CA Practitioner - Nurse Practitioner 7810111390 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northbay Physicians Surgery Center, LLCGroup PAC ID 0042122244, 336 clinicians
Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians

Practice addresses (Care Compare)

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552
Phone (707) 429-3600

1860 Pennsylvania Ave
Fairfield, CA 94533-3590
Phone (707) 646-4114

Hospital & facility affiliations

  • Northbay Medical Center Hospital, Fairfield, CA, CCN 050367

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
234142AZMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group Past 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 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": "1398038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1790105567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 S MAIN ST STE 1300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381035513",
            "telephone_number": "866-949-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15333 N PIMA RD STE 305",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852602717",
            "telephone_number": "866-949-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "LISA",
        "middle_name": "K.",
        "credential": "RN, CCRN, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-21",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024171479",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "234142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

Verify at the official NPI Registry.