Lisa Michelle Matuga, LISA MATUGA, PA-C
Individual provider Active NPI Medical Physician Assistant · Charlotte, NC
NPI 1982854774 · NPPES record last updated Feb 7, 2017
Key facts
- NPI
- 1982854774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 0010-02499 (NC)
- Practice address
- 14214 Ballantyne Lake Rd
Suite 100
Charlotte, NC 28277-3373 - Phone
- (704) 667-2650
- Fax
- (704) 544-0172
- NPI assigned
- Sep 29, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dermatology Care of Charlotte PA
Practice addresses (Care Compare)
15830 Ballantyne Medical PL
Suite 100
Charlotte, NC 28277-0762
Phone (704) 341-0090
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20101208000317 | NC | Practitioner - Physician Assistant | 6406916980 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005362 | MI | MD | Medical Physician Assistant |
| 0010-02499 | NC | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatologic Surgery of the Carolinas LLC | Current | Accepting new patients | |
| Carolinas Physicians Network Inc | Past | Accepting new patients | |
| Carolinas Physicians Network Inc | Past | Accepting new patients | |
| Union Urgent Care LLC | Past | Accepting new patients | |
| Carolinas Physicians Network Inc | Past | Accepting new patients | |
| Carolinas Physicians Network Inc | Past | Accepting new patients | |
| Carolinas Physicians Network Inc | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JGGEAA
- lisa-matuga@dermcarecharlotte.e-mdsdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601005362 | MI | |
| Medical Physician Assistant | 363AM0700X | 0010-02499 | NC | Yes |
Addresses
Primary practice location
14214 Ballantyne Lake Rd
Suite 100
Charlotte, NC 28277-3373
Mailing address
15830 Ballantyne Medical PL
Ste 100
Charlotte, NC 28277-0762
Phone (704) 667-2650
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8101140 | Medicaid | NC |
Other providers in Charlotte, NC
- Cristine Mattis
- Hannah Rae Mattocks
- Larry Mattocks
- Lillie Mattox
- Sandra Gay Mattson
- Justin Thomas Matulay
- Melissa Dawne Matulis
- Marlena Nicole Matusewicz
- Jeffrey Earle Matz
- Arielle Christina Mauceri
All providers in Charlotte, NC · Medical Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2017. 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.