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KIMBERLY LAUREN GREENWOOD LISAC
NPI 1043994197
Counselor - Addiction (Substance Use Disorder) in Mesa, AZ

Active since June 09, 2023PECOS Enrolled
6262 E BROADWAY RD STE 110, MESA, AZ 85206(480) 210-5570 Get Directions Write a Review

NPPES record last updated: March 10, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 10, 2025, Jun 9, 2023 (2 updates tracked since 2023).

About Kimberly Lauren Greenwood Lisac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY LAUREN GREENWOOD LISAC (NPI 1043994197) is an individual addiction (substance use disorder) provider in Mesa, Arizona, licensed in Arizona (LISAC-155279) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1043994197
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameKIMBERLY LAUREN GREENWOODCredential: LISAC
Location Address6262 E BROADWAY RD STE 110Mesa, AZ 85206-6101
Mailing Address6262 E Broadway Rd Ste 110Mesa, AZ 85206-6101 · (480) 210-5570
Phone(480) 210-5570
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateJune 9, 2023
Last NPPES UpdateMarch 10, 20252 updates tracked since enumeration
NPPES CertifiedMarch 10, 2025
✔ NPI 1043994197 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in AZ · LISAC-155279
6262 E BROADWAY RD STE 110, Mesa, AZ 85206
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kimberly Lauren Greenwood Lisac is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2769959691
PECOS Enrollment IDI20260428001827
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOBA MESA LLC
Substance Abuse Rehabilitation Facility
6262 E BROADWAY RD STE 110
MESA, AZ 85206
Maricopa County (480) 664-4053
ERIK ADAIR JOHNSON
Counselor
6262 E BROADWAY RD STE 110
MESA, AZ 85206
Maricopa County (480) 664-4058

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Greenwood's NPI number?

The NPI number for Kimberly Greenwood is 1043994197. It was assigned to this individual provider in the NPPES registry on June 9, 2023.

Where is Kimberly Greenwood located?

Kimberly Greenwood practices at 6262 E Broadway Rd Ste 110, Mesa, AZ 85206. The listed phone number is (480) 210-5570.

What is Kimberly Greenwood's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Kimberly Greenwood enrolled in Medicare?

Yes. Kimberly Greenwood is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kimberly Greenwood was last updated on March 10, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.