NPIMap

Organization Active NPI

Lisa Medwedeff M.D. PA

  • Specialist
  • Plano, TX
National Provider Identifier
1982843769
Registry record updated Jul 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K1257 Issued in TX
Legal business name
LISA MEDWEDEFF M.D. PA
Practice address
5425 W Spring Creek Pkwy
Ste 210
Plano, TX 75024-4236
Phone
(972) 608-3333
Fax
(972) 473-7333
NPI assigned
Feb 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2014

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

Authorized official

Name
Lisa E Medwedeff, MD PANPI 1104827799
Title
Physician/Owner
Phone
(972) 608-3333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X K1257 TX Primary

Addresses

Primary practice location

5425 W Spring Creek Pkwy
Ste 210
Plano, TX 75024-4236

Mailing address

5425 W Spring Creek Pkwy
Ste 210
Plano, TX 75024-4236
Phone (972) 608-3333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090423000734 TX Part B Supplier - Clinic/Group Practice 6204984685 Receives reassigned benefits from 6 practitioners
Practice locations: Plano, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1234915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1982843769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5425 W SPRING CREEK PKWY",
            "address_2": "STE 210",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750244236",
            "telephone_number": "972-608-3333",
            "fax_number": "972-473-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5425 W SPRING CREEK PKWY",
            "address_2": "STE 210",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750244236",
            "telephone_number": "972-608-3333",
            "fax_number": "972-473-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA MEDWEDEFF M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-18",
        "last_updated": "2014-07-10",
        "status": "A",
        "authorized_official_last_name": "MEDWEDEFF",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "972-608-3333",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "K1257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.