LISA NIELSEN M.D.
NPI 1598706970
Family Medicine in Island Falls, ME
NPI Status: Active since June 09, 2006
Contact Information
1300 CRYSTAL RD
ISLAND FALLS, ME
ZIP 04747
Phone: (207) 463-3600
Fax: (207) 463-3603
- Individual
- Female
- Years of Experience 35
- Family Medicine
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About LISA NIELSEN
This page provides the complete NPI Profile along with additional information for Lisa Nielsen, a primary care provider established in Island Falls, Maine with a medical specialization in Family Medicine and more than 35 years of experience. She graduated from New York University School Of Medicine in 1991. The healthcare provider is registered in the NPI registry with number 1598706970 assigned on June 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 013731 (ME). The provider is registered as an individual and her NPI record was last updated 9 years ago.
- NPI
- 1598706970
- Provider Name
- LISA NIELSEN M.D.
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1300 CRYSTAL RD ISLAND FALLS, ME 04747
- Location Phone
- (207) 463-3600
- Location Fax
- (207) 463-3603
- Mailing Address
- PO BOX 500 PATTEN, ME 04765
- Mailing Phone
- (207) 528-2285
- Mailing Fax
- (207) 463-3603
- Medical School Name
- NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 1991
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-09-2006
- Last Update Date
- 04-04-2016
- Code Navigator
A primary care provider (PCP) like Lisa Nielsen sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 013731
- License State
- ME
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Access Blue New England HMO 5000/10%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 5000/20%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 6500/30%/9200 Value - HMO
- Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
- Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 144828 | OTHER (01) | ME | AETNA GROUP |
| 5236796 | OTHER (01) | ME | CIGNA |
| F77297 | MEDICARE UPIN (02) | ME | |
| 298050099 | MEDICAID (05) | ME | |
| 048673 | OTHER (01) | ME | ANTHEM STAR # |
| 119411700 | OTHER (01) | ME | FEDERAL W/C GROUP |
| 203814 | OTHER (01) | ME | NHIC GROUP PTAN |
| MM5344 | MEDICARE ID-TYPE UNSPECIFIED (04) | ME | MEDICARE |
| P00301812 | OTHER (01) | ME | RR MEDICARE |
| F77297 | OTHER (01) | ME | HARVARD PILGRAM |
Medicare Participation & PECOS Enrollment Status
Lisa Nielsen is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Lisa Nielsen is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 5193777282
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20050217000057
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
8 DME suppliers used 19 Medicare Claims 47 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Lancets, per box of 100 (HCPCS:A4259)
5 DME suppliers used 15 Medicare Claims 22 Services Paid
DME-Other DME (DE005N)
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)
1 DME suppliers used 24 Medicare Claims 24 Services Paid
DME-Other DME (DE000N)
Nebulizer, with compressor (HCPCS:E0570)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
2 DME suppliers used 19 Medicare Claims 19 Services Paid
Orthotic Devices
DME-Orthotic Devices (DF010N)
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each (HCPCS:A4390)
1 DME suppliers used 12 Medicare Claims 200 Services Paid
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Detection test by immunoassay with direct visual observation for influenza virus
Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)
Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)
Hemoglobin a1c level
Routine electrocardiogram (ecg) using at least 12 leads with tracing
Testing for presence of drug, read by direct observation
Urinalysis, manual test
This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.
This service was performed 13 times for 12 patientsThis is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.
This service was performed 37 times for 36 patientsA detection test by immunoassay for Group A Strep is a quick procedure to identify a bacterial infection in your throat. It involves taking a throat swab and applying it to a test strip, which changes color if Strep bacteria are present.
This service was performed 18 times for 16 patientsHemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
This service was performed 53 times for 44 patientsAn Electrocardiogram (ECG) is a simple, painless test that records the heart's electrical activity. Using 12 leads attached to your skin, it generates a tracing of your heart rhythm. It helps detect any heart problems by showing the timing and strength of electrical signals passing through each part of your heart.
This service was performed 42 times for 40 patientsTesting for the presence of drugs involves collecting a sample, usually urine, which is then analyzed for specific substances. The process is monitored directly to ensure accuracy and integrity. This test helps to confirm if drugs are present in your system.
This service was performed 25 times for 25 patientsA urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.
This service was performed 109 times for 81 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $20.64 for a new patient copayment and $23.65 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 04747 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $82.58
- Minimum New Patient Price $53.26
- Maximum New Patient Price $162.77
- Average New Patient Copayment $20.64
- Minimum New Patient Copayment $13.31
- Maximum New Patient Copayment $40.69
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $94.6
- Minimum Established Patient Price $16.9
- Maximum Established Patient Price $132.79
- Average Established Patient Copayment $23.65
- Minimum Established Patient Copayment $4.22
- Maximum Established Patient Copayment $33.19
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Breast Cancer Screening | 61% | 487 |
| Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer | ||
| Chronic Care and Preventative Care Management for Empaneled Patients | Yes | N/A |
| Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation. | ||
| Colorectal Cancer Screening | 58% | 965 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Diabetes: Eye Exam | 32% | 303 |
| Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period | ||
| e-Prescribing | 98% | 7009 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Health Information Exchange | 75% | 545 |
| The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral. | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Medication Reconciliation | 97% | 244 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 80% | 3717 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Provide Patient Access | 100% | 3717 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 22% | 3717 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Specialized Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Lisa Nielsen is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| NORTHERN LIGHT A R GOULD HOSPITAL | PO BOX 151 PRESQUE ISLE, ME 04769 | (207) 768-4000 | Acute Care Hospitals | |
| HOULTON REGIONAL HOSPITAL | 20 HARTFORD STREET HOULTON, ME 04730 | (207) 532-2900 | Critical Access Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 9 | 8 | 7 | 0 | 6 | 9 | 7 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 18 | 8 | 14 | 0 | 12 | 9 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 1 + 8 + 8 + 1 + 4 + 0 + 1 + 2 + 9 + 1 + 4 + 24 = 70 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1598706970 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1932431871 | SHARON R WALKER RN Individual | Registered Nurse | 1300 CRYSTAL RD ISLAND FALLS, ME 04747 (207) 528-2285 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1598706970, enumerated in the NPI registry as an "individual" on June 09, 2006
The provider is located at 1300 Crystal Rd Island Falls, Me 04747 and the phone number is (207) 463-3600
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
The provider has more than 35 years of experience. She graduated from New York University School Of Medicine in 1991.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Aetna,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $82.58 with an average copayment of $20.64 for new patient appointments. Established patients should expect a typical charge of $94.6 and an average copayment of 23.65. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Detection test by immunoassay with direct visual observation for influenza virus, Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19), Detection test by immunoassay with direct visual observation for streptococcus, group a (strep), Hemoglobin a1c level, Routine electrocardiogram (ecg) using at least 12 leads with tracing, Testing for presence of drug, read by direct observation and Urinalysis, manual test.
The practitioner is affiliated to the following hospital(s): NORTHERN LIGHT A R GOULD HOSPITAL and HOULTON REGIONAL HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on June 09, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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