LISA M MOORE (PA-C) – Physician Assistant, NPI 1659456630
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,167 PHYSICIAN ASSISTANT in ME
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Provider Addresses for LISA M MOORE (PA-C)
Gannett Drive, South Portland, Cumberland County, Maine, 04092, United States
SOUTH PORTLAND, ME 041063266
Phone: (207) 482-7800
Fax: (207) 482-7898
Type: Mailing
690 MINOT AVE
AUBURN, ME 042103922
Phone: (207) 783-1328
Type: Mailing
1, Minot Avenue, Auburn, Androscoggin County, Maine, 04210, United States
AUBURN, ME 042103922
Phone: (207) 783-1328
Fax: (207) 786-4332
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-12-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100609000307 | I | Physician Assistant | MA | TBD |
| I20190109000820 | I | Physician Assistant | FL | TBD |
| I20201209003285 | I | Physician Assistant | ME | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 04106)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | AL | |
| P O D I A T R Y | ME | |
| Certified Registered Nurse Anesthetist (Crna) | ME | |
| Nurse Practitioner | ME | |
| - | ME | |
| - | OR | |
| - | ME | |
| Critical Care (Intensivists), Sleep Medicine, Critical Care (Intensivists), Pulmonary Disease, Pulmonary Disease | ME | |
| - | NH | |
| Nurse Practitioner | ME |
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