Desta Lissanu, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

290272 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2621

Phone

(617) 726-9550

NPI assigned

Mar 19, 2019

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

Medicare fee-for-service enrollment

Enrolled in MA

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 1

Specialty

Psychiatry

Education

University of Chicago, Pritzker School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Massachusetts General Hospital Hospital, Boston, MA, CCN 220071

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573

  Psychiatry

  Medicare reassignment Care Compare group NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD

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

• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Care Compare affiliation

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681603200000",
    "number": "1942769773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 WELD HILL ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-9550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "58 Weld Hill St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021304187",
            "country_code": "US",
            "telephone_number": "617-982-3152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LISSANU",
        "first_name": "DESTA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2023-04-16",
        "certification_date": "2023-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "290272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Lisbon, M.D.
• Natasa Lisica, RN
• Steven K Lisica, MD
• Natalie Lisiewicz, AUD
• Victoria Lisowski
• Taylor Marie Lissarrague
• Brianne Lista, CNP
• Dianna Lister, O.D.
• Edward Liston Kraft, PHD
• Matthew Litchfield, PHARMD, RPH

• Psychiatry Physician in Boston, MA
• Providers in Boston, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2023; 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.