MS. LISA D RADERSTORF (PA-C) – Physician Assistant, NPI 1245421031
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for MS. LISA D RADERSTORF (PA-C)
PO BOX 1239
TROY, MI 480991239
Phone: (248) 824-6600
Fax: (248) 324-1477
Type: Mailing
5838 W BRICK RD
SUITE 106
SOUTH BEND, IN 466288423
Phone: (574) 247-1911
Fax: (574) 247-1912
Type: Location
211 N EDDY ST
SOUTH BEND, IN 466173096
Phone: (574) 234-8161
Type: Mailing
52500 FIR RD
GRANGER, IN 465308579
Phone: (574) 271-0700
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2012-06-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20070823000328 | I | Physician Assistant | IN | TBD |
| I20120611000446 | I | Physician Assistant | MI | 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 48099)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| - | IN | |
| - | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | IN | |
| - | IN | |
| Family Practice | KY | |
| Family Practice | IN | |
| O P H T H A L M O L O G Y | IN | |
| Physician Assistant | IN | |
| Family Practice | IN |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.