Lisa Marie Peterson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3215-035 Issued in WI

Practice address

1626 Tuttle St Ste 1
Baraboo, WI 53913-1501

Phone

(608) 356-2020

Fax

(608) 355-7055

NPI assigned

Jun 2, 2011

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 1

Other names 1

• Dr. Lisa Marie Pertz Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ho Chunk NationGroup PAC ID 5496709867, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lpeterson259992@direct-ehr-ssmhc.com

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.

• Ho-Chunk Nation

  • Federally Qualified Health Center (FQHC)
  • Black River Falls, WI
  • NPI 1407911795
  Medicare reassignment Care Compare group NPD
• Vision Mart Inc

  • Optician
  • Milwaukee, WI
  • NPI 1366491227

  Optometrist

  Medicare reassignment NPD
• Ho Chunk Nation

  • Federally Qualified Health Center (FQHC)
  • Baraboo, WI
  • NPI 1316002694
  NPD
• Vision Mart, Inc

  • Optician
  • Milwaukee, WI
  • NPI 1184753352
  NPD

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1881988244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 TUTTLE ST STE 1",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131501",
            "telephone_number": "608-356-2020",
            "fax_number": "608-355-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 TUTTLE ST STE 1",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131501",
            "telephone_number": "608-356-2020",
            "fax_number": "608-355-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-02",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3215-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881988244",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpeterson259992@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "lpeterson259992@direct-ehr-ssmhc.com",
            "address_1": "1626 Tuttle St Ste 1",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539131501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1626 Tuttle St Ste 1",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539131501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "PERTZ",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresa Parker, MSW, CICSW
• Mark D Paschen, DDS
• Khushbuben V Patel
• Paul B Webb LLC
• Katie Peper, NP
• Joel D Petty
• Jamie R Petzke, MD
• Linda J. Pfeiffer, M.S.
• Khloe Jean Pierce-Odebunmi, APSW, SAC
• Gina Pierce, LPTA

• Optometrist in Baraboo, WI
• Providers in Baraboo, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; 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.