Individual provider Active NPI

Lisa Diane Wilson, PSY.D.

  • Clinical Psychologist
  • Olathe, KS
National Provider Identifier
1881878916
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP03197 Issued in KS
Practice address
21350 W 153Rd St
Olathe, KS 66061-5413
Phone
(913) 322-2400
Fax
(913) 621-5730
NPI assigned
Dec 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X T-LP1703 KS
Clinical Psychologist 103TC0700X LP03197 KS Primary

Addresses

Primary practice location

21350 W 153Rd St
Olathe, KS 66061-5413

Mailing address

11642 Garnett St
Overland Park, KS 66210-3435
Phone (913) 370-6541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230124000168 KS Practitioner - Clinical Psychologist 5193196525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Oaks Mental Health Associates PCGroup PAC ID 2264337013, 55 clinicians

Practice addresses (Care Compare)

7101 E 21St St N
Wichita, KS 67206-1044
Phone (888) 365-6271

8900 Parallel Pkwy
Kansas City, KS 66112-1637
Phone (888) 365-6271

9100 Park St
Lenexa, KS 66215-3353
Phone (888) 365-6271

Merit-based Incentive Payment System (MIPS)

Final score
91.16 of 100Reported as group
Quality
80.99
Improvement activities
40
Cost
72.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP03197KSMDClinical Psychologist
T-LP1703KSMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Mental Health Associates PC Clinical CurrentSince Feb 1, 2023 Accepting new patients

Locations

7101 E 21st St N
Wichita, KS 67206
Phone (316) 682-8909

7272 Wurzbach Rd
Ste 601
San Antonio, TX 78240
Phone (210) 615-3472

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.

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1881878916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11642 GARNETT ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662103435",
            "telephone_number": "913-370-6541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21350 W 153RD ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660615413",
            "telephone_number": "913-322-2400",
            "fax_number": "913-621-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LISA",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-26",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KS",
            "license": "T-LP1703",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "LP03197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

Verify at the official NPI Registry.