NPIMap

Individual provider Active NPI

Lisa Clough, FNP

  • Family Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1841459690
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5716 Issued in CO
Practice address
3676 Parker Blvd
Suite 260
Pueblo, CO 81008-2212
Phone
(719) 553-2201
Fax
(719) 553-2224
NPI assigned
Jun 6, 2008
Last updated
Jun 6, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5716 CO Primary

Addresses

Primary practice location

3676 Parker Blvd
Suite 260
Pueblo, CO 81008-2212

Mailing address

PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 553-2200

Other identifiers 1

IdentifierTypeStateIssuer
5716OtherCOSTATE LISCENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20080906000187 CO Practitioner - Nurse Practitioner 8224104799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Clinic PCGroup PAC ID 4284524067, 36 clinicians

Practice addresses (Care Compare)

3676 Parker Blvd
Suite 290
Pueblo, CO 81008-2214
Phone (719) 553-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5716COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Clinic PC CurrentSince Apr 25, 2011 Accepting new patients

Locations

3676 Parker Blvd
Pueblo, CO 81008
Phone (719) 253-7000

3676 Parker Blvd
Ste 260
Pueblo, CO 81008
Phone (719) 553-2201

3676 Parker Blvd
Ste 290
Pueblo, CO 81008
Phone (719) 553-2200

Interoperability endpoints

  • Direct secure messaging: lisa.clough.1@21306.direct.athenahealth.com

Organizations & group practices 1

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212710400000",
    "number": "1841459690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810089000",
            "telephone_number": "719-553-2200",
            "fax_number": "719-553-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD",
            "address_2": "SUITE 260",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082212",
            "telephone_number": "719-553-2201",
            "fax_number": "719-553-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUGH",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-06",
        "last_updated": "2008-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "5716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LISCENSE",
            "identifier": "5716",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.