Lisa L Doherty, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60132321 Issued in WA

Practice address

1615 Delaware St
Longview, WA 98632-2367

Phone

(360) 414-2385

Fax

(360) 414-2386

NPI assigned

Jul 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Brody School of Medicine at East Carolina University, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ldoherty10702@direct.peacehealth.org

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.

• Peacehealth

  dba St. John Medical Center - PeaceHealth Medical Group

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Peacehealth

  dba St. John Medical Center

  • General Acute Care Hospital
  • Longview, WA
  • NPI 1073510277
  NPD (past)
• Peacehealth

  dba St. John Medical Center - Outpatient Therapy

  • Physical Therapist
  • Longview, WA
  • NPI 1275501538
  NPD (past)

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

• Peacehealth

  dba St. John Medical Center

  • General Acute Care Hospital
  • Longview, WA
  • NPI 1073510277
  Care Compare affiliation

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288742400000",
    "number": "1871791236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3002",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986320302",
            "telephone_number": "360-414-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-2385",
            "fax_number": "360-414-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "LISA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-06",
        "last_updated": "2010-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60132321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500618521",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2006642",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0261154",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaytlin Ditzler, CPSS
• Ryleigh Dobbins
• John W Dobosz, D.C.
• David Matthew Dodge, DMD
• Julie Doherty
• Lucas Clair Dolan
• Jordyn Dole, MA, LMHCA
• Jared Doman, DMD
• Hilary Gwen Don'T Mix, AAC, SUDPT
• Donald G. Echols DDS (Cowlitz Periodontal care & Implant surgary)

• Family Medicine Physician in Longview, WA
• Providers in Longview, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.