NPIMap

Individual provider Active NPI

Lisa C Grant, M.D.

  • Neurology Physician
  • The Dalles, OR
National Provider Identifier
1801805627
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD24969 Issued in OR
Practice address
1615 E 12TH St
Suite 100
The Dalles, OR 97058-3278
Phone
(541) 296-1100
Fax
(541) 236-0606
NPI assigned
Aug 8, 2006
Last updated
Dec 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD24969 OR Primary

Addresses

Primary practice location

1615 E 12TH St
Suite 100
The Dalles, OR 97058-3278

Mailing address

1615 E 12TH St
Suite 100
The Dalles, OR 97058-3278
Phone (541) 296-1100

Other identifiers 2

IdentifierTypeStateIssuer
233198MedicaidOR
8402315MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040811000424 OR Practitioner - Neurology 4082686985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Tulane University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mid-Columbia Medical CenterGroup PAC ID 3779487251, 99 clinicians

Practice addresses (Care Compare)

551 Lone Pine Blvd
The Dalles, OR 97058-9403
Phone (541) 506-6920

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD24969ORMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Columbia Medical Center CurrentSince Feb 1, 2006 Accepting new patients
Healthcare for the Mid-Columbia Region Current Accepting new patients
Mid-Columbia Medical Center CurrentSince Feb 1, 2006 Accepting new patients
Mid-Columbia Medical Center Past Accepting new patients
Mid-Columbia Medical Center Past Accepting new patients

Locations

1700 E 19th St
The Dalles, OR 97058
Phone (541) 296-7251

1805 E 19th St
The Dalles, OR 97058
Phone (541) 296-2201

1810 E 19th St
Ste 211
The Dalles, OR 97058
Phone (503) 292-1400

1810 E 19th St
Ste 225
The Dalles, OR 97058
Phone (541) 296-6101

551 Lone Pine Blvd
The Dalles, OR 97058
Phone (541) 296-7202

Interoperability endpoints

  • Direct secure messaging: lgrant106460@direct.ohsu.edu
  • Direct secure messaging: lisa.grant.1@7616.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1801805627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 E 12TH ST",
            "address_2": "SUITE 100",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583278",
            "telephone_number": "541-296-1100",
            "fax_number": "541-236-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 E 12TH ST",
            "address_2": "SUITE 100",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583278",
            "telephone_number": "541-296-1100",
            "fax_number": "541-236-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "LISA",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD24969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "233198",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8402315",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Dalles, OR

Sources for this page

Verify at the official NPI Registry.