Individual provider Active NPI

R Lisa Kaufman, NP

  • Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1891761946
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
200050 Issued in MA
Practice address
630 Plantation St
Worcester, MA 01605
Phone
(508) 595-2505
Fax
(508) 854-0650
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 200050 MA Primary

Addresses

Primary practice location

630 Plantation St
Worcester, MA 01605

Mailing address

630 Plantation St
Wot 12TH Floor Attn Physician Services
Worcester, MA 01605
Phone (508) 368-5529

Other identifiers 10

IdentifierTypeStateIssuer
0391310MedicaidMA
042472266OtherTHREE RIVERS
042472266008OtherTRICARE CHAMPUS
NP3652OtherBLUE SHIELD HMO BLUE
NP3652OtherBLUE SHIELD INDEMNITY
NP3652OtherBLUE CARE ELECT
AA635OtherHARVARD PILGRIM HEALTHCAR
0391310OtherMEDICAID WELFARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
61996OtherFALLON COMMUNITY HEALTH P

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
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Emergency Physician Foundation, Inc. Past Accepting new patients
Reliant Medical Group, Inc PastSince Oct 15, 2007 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398643200000",
    "number": "1891761946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "address_2": "WOT 12TH FLOOR ATTN PHYSICIAN SERVICES",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01605",
            "telephone_number": "508-368-5529",
            "fax_number": "508-368-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01605",
            "telephone_number": "508-595-2505",
            "fax_number": "508-854-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "R LISA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2014-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "200050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0391310",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THREE RIVERS",
            "identifier": "042472266",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE CHAMPUS",
            "identifier": "042472266008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD HMO BLUE",
            "identifier": "NP3652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD INDEMNITY",
            "identifier": "NP3652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE ELECT",
            "identifier": "NP3652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTHCAR",
            "identifier": "AA635",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WELFARE",
            "identifier": "0391310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "042472266",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMMUNITY HEALTH P",
            "identifier": "61996",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.