LISTA MARIE DALLIS
NPI 1104468610
Nurse Practitioner - Family in Tahlequah, OK
About Lista Marie Dallis NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LISTA MARIE DALLIS (NPI 1104468610) is an individual family provider in Tahlequah, Oklahoma, licensed in Oklahoma (99753) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS, is affiliated with Northeastern Health System, and is a graduate of Other (2019).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Lista Marie Dallis is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Lista Dallis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Tahlequah, OK 74464
- Reassigned Medicare billing, Oklahoma enrollment
- 65 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Northeastern Health System
Acute Care Hospitals · Tahlequah, OKPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 74464 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TAHLEQUAH, OK 74464
TAHLEQUAH, OK 74464
TAHLEQUAH, OK 74464
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 Lista Dallis's NPI number?
The NPI number for Lista Dallis is 1104468610. It was assigned to this individual provider in the NPPES registry on October 16, 2019.
Where is Lista Dallis located?
Lista Dallis practices at 1500 E Downing St Ste 214, Tahlequah, OK 74464. The listed phone number is (918) 413-0202.
What is Lista Dallis's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Lista Dallis enrolled in Medicare?
Yes. Lista Dallis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Lista Dallis's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Lista Dallis reassigns Medicare benefits to Northeastern Oklahoma Community Health Centers, Inc. (Tahlequah, OK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lista Dallis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Lista Dallis accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Lista Dallis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Lista Dallis affiliated with any hospitals?
According to CMS data, Lista Dallis is affiliated with Northeastern Health System.
When was this NPI record last updated?
The NPPES record for Lista Dallis was last updated on February 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lista Marie Dallis · NPI 1104468610
Family physician in Tahlequah, Oklahoma. Individual provider, active in the CMS NPPES registry since October 16, 2019.
## Identity
- **NPI:** 1104468610 (Entity type: Individual)
- **Enumerated:** October 16, 2019
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 99753 (Oklahoma)
- **Sole proprietor:** No
## Practice location
- **Address:** 1500 E DOWNING ST STE 214, Tahlequah, OK 74464-3379
- **Phone:** (918) 413-0202 · **Fax:** (918) 431-0203
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Northeastern Oklahoma Community Health Centers, Inc. (NPI 1063188878, Tahlequah, OK), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** February 17, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1104468610) · Data from the CMS NPPES public registry.