NPIMap

Individual provider Active NPI

Lisa L Wimberley, PA

  • Physician Assistant
  • Port Aransas, TX
National Provider Identifier
1871731463
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03594 Issued in TX
Practice address
600 Cut Off Rd Ste 14
Port Aransas, TX 78373-4246
Phone
(361) 749-1930
NPI assigned
Feb 4, 2009
Last updated
Oct 3, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA03594 TX Primary

Addresses

Primary practice location

600 Cut Off Rd Ste 14
Port Aransas, TX 78373-4246

Mailing address

600 Cut Off Rd Ste 14
Port Aransas, TX 78373-4246
Phone (361) 749-1930

Other identifiers 3

IdentifierTypeStateIssuer
213446202MedicaidTX
213446201MedicaidTX
213446203MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20190611000031 AZ Practitioner - Physician Assistant 8426197765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Salim Medical LLCGroup PAC ID 6709156961, 3 clinicians
Salim Medical Urgent Care IncGroup PAC ID 8022376698, 2 clinicians

Practice addresses (Care Compare)

1465 E Northern Ave
Kingman, AZ 86409-2402
Phone (928) 757-5522

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kingman Healthcare, Inc Current Accepting new patients
Lone Star Medical Associates PLLC PastSince Aug 1, 2024 Accepting new patients
Twin Fountains Urgent Care Center Past Accepting new patients
Robert M. Scharf, M.D. Past Accepting new patients
Kingman Healthcare, Inc Physician Assistant Past Accepting new patients
C H Wilkinson Physician Network Past Accepting new patients
Mohave Desert Radiology PLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJAEDD
  • Direct secure messaging: lisa.wimberley.1@29712.direct.athenahealth.com
  • Direct secure messaging: wimberley.lisa@st.direct.azkrmc.md

Organizations & group practices 9

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 1

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": "1233705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1871731463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CUT OFF RD STE 14",
            "city": "PORT ARANSAS",
            "state": "TX",
            "postal_code": "783734246",
            "telephone_number": "361-749-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CUT OFF RD STE 14",
            "city": "PORT ARANSAS",
            "state": "TX",
            "postal_code": "783734246",
            "telephone_number": "361-749-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLEY",
        "first_name": "LISA",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-04",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213446202",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213446201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213446203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Aransas, TX

Sources for this page

Verify at the official NPI Registry.