LISTA MARIE DALLIS
NPI 1104468610
Nurse Practitioner - Family in Tahlequah, OK

Q: 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.

Q: What is Lista Dallis's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: 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.

Active since October 16, 2019PECOS EnrolledAccepts Medicare Assignment

1500 E DOWNING ST STE 214, TAHLEQUAH, OK 74464(918) 413-0202(918) 431-0203 Get Directions Write a Review

NPPES record last updated: February 17, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 17, 2022, Oct 16, 2019 (2 updates tracked since 2019).

On this page

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

NPI1104468610

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameLISTA MARIE DALLIS

Location Address1500 E DOWNING ST STE 214Tahlequah, OK 74464-3379

Mailing AddressPo Box 751Hulbert, OK 74441-0751 · (187) 723-3990 · Fax (918) 772-3638

Phone(918) 413-0202

Fax(918) 431-0203

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateOctober 16, 2019

Last NPPES UpdateFebruary 17, 20222 updates tracked since enumeration

NPPES CertifiedFebruary 17, 2022

✔ NPI 1104468610 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in OK · 99753

1500 E DOWNING ST STE 214, Tahlequah, OK 74464

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

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

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.

PECOS PAC ID9032545595

PECOS Enrollment IDI20200203000406

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.

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.

Hemoglobin a1c level 83036

Hemoglobin 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.

36 services17 patients

Detection test by immunoassay with direct visual observation for influenza virus 87804

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.

36 services16 patients

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) 87811

This 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.

25 services23 patients

Urinalysis, manual test 81002

A 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.

18 services16 patients

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, OK

2/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number370089

Location1400 East Downing StreetTahlequah, OK 74465 · Cherokee County

Emergency services Birthing friendly

Physician 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.

New Patient

$82.46 typical visit price

range $53.00 – $162.61

Typical copayment $20.61 (range $13.25 – $40.65)

Most-billed visit code 99203

Established Patient

$94.27 typical visit price

range $16.68 – $132.40

Typical copayment $23.56 (range $4.17 – $33.10)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

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

ANGELA M WIGGINS APRN CNP

Nurse Practitioner (Family)