Lisa C. Mazzullo, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

737 N Michigan Ave
Suite 950
Chicago, IL 60611-2615

Phone

(312) 751-7515

Fax

(312) 751-1208

NPI assigned

May 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 22, 2017 through May 22, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lisa.mazzullo.1@29023.direct.athenahealth.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.

• The Women's Practice

  • Obstetrics & Gynecology Physician
  • Chicago, IL
  • NPI 1669651857
  NPD (past)
• The Womens Practice

  • Obstetrics & Gynecology Nurse Practitioner
  • Chicago, IL
  • NPI 1699985325
  NPD (past)
• Together Women's Health Medical Group of Illinois, PLLC

  • Specialist
  • Chicago, IL
  • NPI 1912161100
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952354342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W DELAWARE PL",
            "address_2": "UNIT 907",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606103360",
            "telephone_number": "312-751-7515",
            "fax_number": "312-751-1208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 N MICHIGAN AVE",
            "address_2": "SUITE 950",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112615",
            "telephone_number": "312-751-7515",
            "fax_number": "312-751-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZULLO",
        "first_name": "LISA",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lauren Mazzocchi
• Geralyn L Mazzone, LCSW
• Kate Mazzone, LCSW
• Paul Andrew Mazzorana, D.C.
• Jennifer Mazzulli, DNP, PMHNP-BC
• MB Clinical Psychology & Consulting, LLC
• Mba Dental Office PC
• Benjamin Mba, MD
• Dondra O Mbachu, AUD.
• Ephraim Mbachu

• Specialist in Chicago, IL
• Providers in Chicago, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.