NPIMap

Individual provider Active NPI

Despina Lianidis, PA-C

  • Physician Assistant
  • Medford, NJ
National Provider Identifier
1790430692
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00736200 Issued in NJ
Practice address
131 Route 70 Ste 100
Medford, NJ 08055-9501
Phone
(609) 267-9400
NPI assigned
Feb 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 25MP00736200 NJ Primary

Addresses

Primary practice location

131 Route 70 Ste 100
Medford, NJ 08055-9501

Mailing address

131 Route 70 Ste 100
Medford, NJ 08055-9501
Phone (609) 267-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230316002838 NJ Practitioner - Physician Assistant 5092189852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

100 Bowman Dr
Voorhees, NJ 08043-9612
Phone (856) 247-7260

131 Route 70
Suite 100
Medford, NJ 08055-9501
Phone (856) 673-3960

175 Madison Ave
Mount Holly, NJ 08060-2038

200 Bowman Dr
Suite E365
Voorhees, NJ 08043-9639
Phone (856) 247-7295

239 Hurffville Crosskeys Rd
Suite 245
Sewell, NJ 08080-4006
Phone (856) 341-8300

305 Route 70 E
Cherry Hill, NJ 08034-2408

315 Route 70 E
Vitua Express Urgent Care Cherry Hill
Cherry Hill, NJ 08034-2408
Phone (856) 375-6240

3242 Route 206
Bordentown, NJ 08505-4517

570 Egg Harbor Rd
Sewell, NJ 08080-2359

90 Brick Rd
Marlton, NJ 08053-2177
Phone (856) 247-7260

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Jul 19, 2023 Accepting new patients
Virtua Medical Group, PA Physician Assistant CurrentSince Jul 19, 2023 Accepting new patients
Virtua Medical Group, PA Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

243 US Highway 130
Ste 100
Bordentown, NJ 08505
Phone (609) 400-1630

1311 Fairview Blvd
Ste B
Delran, NJ 08075
Phone (856) 368-3216

131 Route 70
#100
Medford, NJ 08055
Phone (856) 630-7468

300 W Route 38
Moorestown, NJ 08057
Phone 60926794001224

Interoperability endpoints

  • Direct secure messaging: dlianidis243016@directvirtua.org

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 7

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": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1790430692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 ROUTE 70 STE 100",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080559501",
            "telephone_number": "609-267-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 ROUTE 70 STE 100",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080559501",
            "telephone_number": "609-267-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIANIDIS",
        "first_name": "DESPINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00736200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

Verify at the official NPI Registry.