Lisa M Manderino

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Practice address

3615 Newburg Rd
Louisville, KY 40218-3368

Phone

(502) 909-0772

Fax

(855) 859-0123

NPI assigned

Mar 13, 2018

Last updated

Oct 13, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aptiva HealthGroup PAC ID 0547595316, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Aptiva Health

  dba Aptiva Health LLC

  • Orthopaedic Surgery Physician
  • Louisville, KY
  • NPI 1669967881

  Clinical Neuropsychologist

  Medicare reassignment Care Compare group NPD
• Aptiva Health

  dba Aptiva Health LLC

  • Durable Medical Equipment & Medical Supplies
  • Elizabethtown, KY
  • NPI 1326877952
  NPD

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1790288066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 NEWBURG RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402183368",
            "telephone_number": "502-909-0772",
            "fax_number": "855-859-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 NEWBURG RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402183368",
            "telephone_number": "502-909-0772",
            "fax_number": "855-859-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDERINO",
        "first_name": "LISA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "276504",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronda L Mancini, PSYD
• Mounika Mandadi, M.D.
• Mandala House, LLC (Mandala House)
• Anupa Mandava, M.D.
• Max Mandelbaum, MD
• Mandran Health PLLC
• John M Mandrola, MD
• Staci A Mandrola, MD
• Kyj Roman Mandzy, DO
• Svitlana J Mandzy, M.D.

• Clinical Neuropsychologist in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Neuropsychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.