LISA JILL VANDIEMEN (FNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1396041885
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for LISA JILL VANDIEMEN (FNP)
12197 CROSS FENCE TRL
TYLER, TX 757064241
Phone: (903) 571-4656
Fax: (903) 881-1994
Type: Location
615 CLINIC DR
LONGVIEW, TX 756055172
Phone: (903) 571-4656
Fax: (903) 881-1994
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 48 Open Payments records for all available years, with a total value of $1,056.
Total Amount is formed as General ($1,056) + Research ($0) + Ownership ($0) = $1,056.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ViiV Healthcare Company ($314).
Total Amount
$1,056
General + Research + Ownership
Payments
48
Total payment records
General Amount
$1,056
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2011-09-28
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 |
|---|---|---|---|---|
| I20110928000395 | I | Nurse Practitioner | TX | 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 75706)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine, Infectious Disease | TX | |
| - | TX | |
| Infectious Disease, Internal Medicine | TX | |
| O B S T E T R I C S/ G Y N E C O L O G Y | TX | |
| P S Y C H I A T R Y | TX | |
| Nurse Practitioner | TX | |
| Anesthesiology, Interventional Pain Management | TX | |
| Nurse Practitioner | TX | |
| Physician Assistant | TX | |
| Nurse Practitioner | TX |
Reviews
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