Individual provider Active NPI

Lisa L. Walter, PAC

  • Surgical Physician Assistant
  • Flint, MI
National Provider Identifier
1912024837
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5601004548 Issued in MI
Practice address
1 Hurley PLZ
Flint, MI 48503-5902
Phone
(810) 257-9191
Fax
(810) 257-9187
NPI assigned
Mar 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5601004548 MI Primary

Addresses

Primary practice location

1 Hurley PLZ
Flint, MI 48503-5902

Mailing address

1 Hurley PLZ
5TH Floor S.O.N.
Flint, MI 48503-5902
Phone (810) 762-7038

Other names 1

  • Lisa L Jasnon Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lwalter1790@direct.hurleymc.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060106000512 MI Practitioner - Physician Assistant 3274556030 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Practice addresses (Care Compare)

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-4220

1941 Gates St
Reese, MI 48757-9555
Phone (989) 583-5550

700 Cooper Ave
Saginaw, MI 48602-5383
Phone (989) 583-4220

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Saginaw, MI, CCN 230070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004548MIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc CurrentSince Jul 27, 2023 Accepting new patients
Hurley Medical Center CurrentSince Sep 19, 2005 Accepting new patients
Hurley Medical Center Physician Assistant CurrentSince Sep 19, 2005 Accepting new patients
Covenant Medical Center, Inc CurrentSince Jul 27, 2023 Accepting new patients

Locations

1 Hurley Plz
Fl 5
Flint, MI 48503
Phone (810) 262-9353

1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

700 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6000

Interoperability endpoints

  • Direct secure messaging: lwalter1790@direct.hurleymc.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1912024837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HURLEY PLZ",
            "address_2": "5TH FLOOR S.O.N.",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485035902",
            "telephone_number": "810-762-7038",
            "fax_number": "810-760-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HURLEY PLZ",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485035902",
            "telephone_number": "810-257-9191",
            "fax_number": "810-257-9187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "LISA",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lwalter1790@direct.hurleymc.com",
            "affiliation": "N",
            "address_1": "1 Hurley Plz",
            "city": "Flint",
            "state": "MI",
            "country_code": "US",
            "postal_code": "485035902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "JASNON",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.