Look up the most recent NPI and PECOS records

Lisa Marie Rivera

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as LISA RIVERA.

Based on the most recent information from CMS, provider Lisa Marie Rivera is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1467040204
Provider Type
Individual
Full Name
Rivera, Lisa Marie
Credential
PA-C

Gender
Female
Sole Proprietor
Yes
Enumeration Date
1/7/2021
Last Updated
3/8/2023

Contact Information

Practice Location

9015 N 3rd St, Phoenix, AZ 85020-2444

(480) 882-4545

(602) 870-6348

Mailing Location

312 N Alma School Rd Ste 11, Chandler, AZ 85224-4354

(602) 762-8142

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 8720 Arizona
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 8720 Arizona
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 718429 Texas

Provider Identifiers

ID	Description	Issuer
ID 105817	Description Medicaid	Issuer Unlisted Arizona

Lisa Marie Rivera

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

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License

Code

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Provider Identifiers

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Description

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ID

Description

Issuer

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Allison, Crystal Dawn

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Mintz, Rose Marie