NPIMap

Individual provider Active NPI

Lois Marlene Dishman-Cooper, MPAS, PA-C

  • Medical Physician Assistant
  • Flora, IL
National Provider Identifier
1851476238
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085-002930 Issued in IL
Practice address
929 Stacey Burk Dr
Flora, IL 62839-3241
Phone
(618) 662-2131
Fax
(618) 662-3077
NPI assigned
Oct 26, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085-002930 IL Primary

Addresses

Primary practice location

929 Stacey Burk Dr
Flora, IL 62839-3241

Mailing address

929 Stacey Burk Dr
Flora, IL 62839-3241
Phone (618) 662-2131

Other identifiers 5

IdentifierTypeStateIssuer
291816100MedicaidFL
MED-PAC-LIC-26883OtherMTSTATE LICENSE
085-002930OtherILLICENSE NUMBER
PA9101866OtherFLPA LICENSE NUMBER
00004500OtherFLPA PRESCRIBER NUMBER

Other names 1

  • Lois Marlene Goines Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-002930ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Acv Community Services LLC Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ldish@yourcarecommunity.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1851476238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISHMAN-COOPER",
        "first_name": "LOIS",
        "middle_name": "MARLENE",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2023-03-07",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-002930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291816100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MED-PAC-LIC-26883",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "085-002930",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE NUMBER",
            "identifier": "PA9101866",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA PRESCRIBER NUMBER",
            "identifier": "00004500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LOIS",
            "last_name": "GOINES",
            "middle_name": "MARLENE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.