LISTA MARIE DALLIS – Family Nurse Practitioner, NPI 1104468610
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,299 NURSE PRACTITIONER in OK
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Provider Addresses for LISTA MARIE DALLIS
214, East Downing Street, Tahlequah, Cherokee County, Oklahoma, 74464, United States
TAHLEQUAH, OK 744643379
Phone: (918) 413-0202
Fax: (918) 431-0203
Type: Location
PO BOX 751
HULBERT, OK 744410751
Phone: (187) 723-3990
Fax: (918) 772-3638
Type: Mailing
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: 2020-02-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20200203000406 | I | Nurse Practitioner | OK | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 61 | 14 | $0 |
| 96372 | Injection of drug or substance under skin or into muscle | 27 | 20 | $0 |
| 87804 | Detection test by immunoassay with direct visual observation for influenza virus | 26 | 12 | $0 |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 20 | 14 | $0 |
| J1030 | Injection, methylprednisolone acetate, 40 mg | 12 | 11 | $0 |
Insurance plans in this area (ZIP 74464)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OK | |
| Nurse Practitioner | OK | |
| Family Practice, Internal Medicine | OK | |
| Nurse Practitioner | OK | |
| Nurse Practitioner | OK | |
| Physician Assistant | OK | |
| Nurse Practitioner | OK | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NY | |
| Nurse Practitioner | OK | |
| Physician Assistant | AR |
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