Individual provider Active NPI

Lisa Baeza Johnson, MD

  • Child & Adolescent Psychiatry Physician
  • Albuquerque, NM
National Provider Identifier
1962514349
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
MD2018-0781 Issued in NM
Practice address
8300 Constitution Ave NE
Albuquerque, NM 87110
Phone
(505) 291-2500
NPI assigned
Aug 31, 2006
Last updated
Sep 28, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X T2002014678 MO
Child & Adolescent Psychiatry Physician 2084P0804X MD2018-0781 NM Primary

Addresses

Primary practice location

8300 Constitution Ave NE
Albuquerque, NM 87110

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Other practice location 1

1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000

Other practice location 2

1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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

Enrollment IDStateProvider typePAC IDDetails
I20181016001468 NM Practitioner - Psychiatry 3971669763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Iowa, RJ & L Carver College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of New MexicoGroup PAC ID 2062412869, 21 clinicians

Practice addresses (Care Compare)

3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Phone (505) 454-2842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T2002014678MOMDPsychiatry Physician
MD2018-0781NMMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of New Mexico Current Accepting new patients

Locations

3695 Hot Springs Blvd
Las Vegas, NM 87701
Phone (505) 454-2100

Interoperability endpoints

  • Direct secure messaging: lisa.johnsonmd.p1@direct.tgcaz.nextgenshare.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1962514349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 CONSTITUTION AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87110",
            "telephone_number": "505-291-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 E Bradford Pkwy",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658044264",
            "country_code": "US",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 E Bradford Pkwy",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658044264",
            "country_code": "US",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LISA",
        "middle_name": "BAEZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "T2002014678",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NM",
            "license": "MD2018-0781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.