Lisa Robin Glass, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Vail, AZ
NPI 1962961615 · NPPES record last updated May 21, 2026
Key facts
- NPI
- 1962961615
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 227363 (AZ)
- Practice address
- 13370 E Mary Ann Cleveland Way Ste 102
Vail, AZ 85641-8610 - Phone
- (520) 585-5002
- Fax
- (520) 585-5008
- NPI assigned
- Mar 12, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Benson Hospital Corporation
Practice addresses (Care Compare)
450 S Ocotillo Ave
Benson, AZ 85602-6403
Phone (520) 586-2261
Hospital & facility affiliations
- Bayada Home Health Care, Inc
- Benson Hospital
- Tucson Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190823003271 | AZ | Practitioner - Nurse Practitioner | 8325376619 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227363 | AZ | MD | Family Nurse Practitioner |
| 344218 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benson Hospital Corporation | Current |
Accepting new patients | |
| Benson Hospital Corporation | Current |
Accepting new patients | |
| Oak Street Health Physicians Group of Arizona PLLC | Family Medicine | Past |
Accepting new patients |
| Codac Health Recovery and Wellness | Past | Accepting new patients | |
| TMC Medical Network | Past |
Accepting new patients |
Locations
450 S Ocotillo St
Benson, AZ 85602
Phone (520) 586-2261
688 W 4th St
Ste B
Benson, AZ 85602
Phone (520) 720-6551
890 W 4th St
Benson, AZ 85602
Phone (520) 586-3664
13370 E Mary Ann Cleveland Way
Ste 102
Vail, AZ 85641
Phone (520) 585-5002
13370 E Mary Ann Cleveland Way
Vail, AZ 85641
Phone (520) 689-7144
Interoperability endpoints
- lisa.cellamiller.1@18129.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 227363 | AZ | Yes |
| Family Nurse Practitioner | 363LF0000X | 344218 | NY |
Addresses
Primary practice location
13370 E Mary Ann Cleveland Way Ste 102
Vail, AZ 85641-8610
Mailing address
85 Fairfield Way Apt 9
Commack, NY 11725-3426
Phone (631) 651-8922
Other practice location 1
2720 S 6th Ave
Tucson, AZ 85713-4701
Phone (520) 475-5418
Other providers in Vail, AZ
- Angela Christene Gage
- Kelly Gallardo
- Angela Christine Garcia
- Jennifer Lynn Garcia
- Anne Hayes Getty
- Glorious Therapy Services LLC
- Adam Robert Godfrey
- Mark A Goforth
- Sussan Lee Goldsworthy
- Isabel Gomez
All providers in Vail, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.