Lucy Elizabeth Modahl, MD, PHD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

M9541 Issued in ID

Practice address

601 Front Avenue
Suite #502
Coeur D Alene, ID 83814

Phone

(208) 415-0524

Fax

(208) 763-3644

NPI assigned

Apr 5, 2006

Last updated

May 26, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in MA, NY, FL3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

University of Southern California Keck School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• NYU Langone Hospitals Hospital, New York, NY, CCN 330214
• Long Island Community Hospital Hospital, Patchogue, NY, CCN 330141

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: lmodahl1940262@nychhc.direct-ci.com
• Direct secure messaging: lmodahl487631@nyumc.direct-ci.com

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.

• New York University

  dba NYU Faculty Group Practice

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  MA, NY

  Medicare reassignment Care Compare group NPD
• New York City Health and Hospitals Corporation

  dba Gouverneur Healthcare Services

  • Clinic/Center
  • New York, NY
  • NPI 1548208127
  Medicare reassignment NPD
• New York City Health and Hospitals Corporation

  dba Renaissance Diagnostic & Treatment Center

  • Clinic/Center
  • New York, NY
  • NPI 1235147497
  NPD
• New York City Health and Hospitals Corporation

  dba Henry J. Carter Specialty Hospital

  • Clinic/Center
  • New York, NY
  • NPI 1538943469
  NPD
• New York University

  dba NYU Langone Ambulatory Care Chelsea

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD
• Piedmont Diagnostic Radiology PC

  • Diagnostic Radiology Physician
  • Martinsville, VA
  • NPI 1467407825
  NPD (past)

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

• NYU Langone Hospitals

  dba NYU Langone Hospitals - Suffolk

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Patchogue, NY
  • NPI 1013724061

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  • Rehabilitation Hospital Unit
  • New York, NY
  • NPI 1275632895
  Care Compare affiliation
• NYU Langone Hospitals

  • Ambulance
  • Brooklyn, NY
  • NPI 1346614443

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  dba NYU Langone Hospital Long Island

  • General Acute Care Hospital
  • Mineola, NY
  • NPI 1427616002
  Care Compare affiliation
• NYU Langone Hospitals

  • Oncology Clinic/Center
  • New York, NY
  • NPI 1437230034

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1619341716
  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • New York, NY
  • NPI 1669578324
  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • New York, NY
  • NPI 1801992631
  Care Compare affiliation
• NYU Langone Hospitals

  dba NYU Langone Hospital - Suffolk

  • General Acute Care Hospital
  • Patchogue, NY
  • NPI 1831910355
  Care Compare affiliation

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243296000000",
    "number": "1902868730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 FRONT AVENUE",
            "address_2": "SUITE #502",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-415-0524",
            "fax_number": "208-763-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 FRONT AVENUE",
            "address_2": "SUITE #502",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-415-0524",
            "fax_number": "208-763-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODAHL",
        "first_name": "LUCY",
        "middle_name": "ELIZABETH",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2009-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M9541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO",
            "identifier": "91725",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00403958",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000548186",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "3425955000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101968783",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WV",
            "identifier": "3810010476",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50017558",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE PA",
            "identifier": "1019687830001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902868730",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100025960",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE NY",
            "identifier": "2950085",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019687930001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rina Jannik Missirian, MD
• John Bernard Mitchell, M.D.
• Kelly Mitchell, LPC
• Mamie Nora Mitchell, LMSW
• Sarah Mitchell, RN
• Michael Mohr, PA
• Stephanie Mokry, B.S. CADC
• Stephanie Rose Moline, M.D.
• Monarch Counseling Services
• Monarch Mental Health

• Diagnostic Radiology Physician in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Diagnostic Radiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; 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.