Active NPI
Lisa M. Watson
- Nurse Practitioner
- Pontiac, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 041217560/209002332
- Practice address
- 1506 W Reynolds St
Pontiac, IL 61764 - Phone
- (815) 844-6123
- Fax
- (815) 844-7851
- NPI assigned
- Oct 1, 2006
- Last updated
- Feb 28, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 041217560/209002332 | IL | Primary |
Addresses
Primary practice location
1506 W Reynolds St
Pontiac, IL 61764
Mailing address
1506 W Reynolds St
Pontiac, IL 61764
Phone (815) 844-6123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
103 W S St
Osf Healthcare Medical Group Flanagan
Flanagan, IL 61740-7547
Phone (815) 796-4591
105 W Hack St
Osf Healthcare Medical Group Cullom
Cullom, IL 60929-7133
Phone (815) 689-2126
106 S 1St St
100 Osf Healthcare Medical Group Fairbury
Fairbury, IL 61739-1509
Phone (815) 692-2308
107 Watters Dr
100 Osf Healthcare Medical Group Dwight
Dwight, IL 60420-1280
Phone (815) 584-3343
1506 W Reynolds St
Osf Healthcare Medical Group Reynolds
Pontiac, IL 61764-9674
Phone (815) 844-6123
2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041217560/209002332 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Saint James Hospital | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Saint James Hospital | Past | Accepting new patients |
Locations
106 S 1st St
Fairbury, IL 61739
Phone (815) 635-3177
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1506 W Reynolds St
Pontiac, IL 61764
Phone (815) 844-6123
2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828
Organizations & group practices 4
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.
-
dba Saint James Hospital - Multiple Hospital Departments
- Anesthesiology Physician
- Pontiac, IL
- NPI 1790735421
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
dba patton pharmacy and v&s variety
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
dba OSF Healthcare - Medical Group - Pontiac
- Rural Health Clinic/Center
- Pontiac, IL
- NPI 1447976113
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Osf Saint James-John W Albrecht Medical Center
- General Acute Care Hospital
- Pontiac, IL
- NPI 1407808090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298851200000",
"number": "1982797254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1506 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "61764",
"telephone_number": "815-844-6123",
"fax_number": "815-844-7851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1506 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "61764",
"telephone_number": "815-844-6123",
"fax_number": "815-844-7851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "LISA",
"middle_name": "M.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-01",
"last_updated": "2011-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "041217560/209002332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.