LISA DEPTULA PA, MD
NPI 1184052508
Student in an Organized Health Care Education/Training Program in Southaven, MS
NPI Status: Active since October 22, 2013
Contact Information
7601 SOUTHCREST PKWY
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 772-3607
- Individual
- Female
- Student in an Organized Health Care Educ...
- PECOS Enrolled
- Opted-Out Medicare
About LISA DEPTULA
This page provides the complete NPI Profile along with additional information for Lisa Deptula, a primary care provider established in Southaven, Mississippi with a medical specialization in Student In An Organized Health Care Education/training Program. The healthcare provider is registered in the NPI registry with number 1184052508 assigned on October 2013. The practitioner's primary taxonomy code is 390200000X. The provider is registered as an individual and her NPI record was last updated one year ago.
- NPI
- 1184052508
- Provider Name
- LISA DEPTULA PA, MD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 7601 SOUTHCREST PKWY SOUTHAVEN, MS 38671
- Location Phone
- (662) 772-3607
- Mailing Address
- 7601 SOUTHCREST PKWY SOUTHAVEN, MS 38671
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-22-2013
- Last Update Date
- 04-22-2025
- Code Navigator
A primary care provider (PCP) like Lisa Deptula 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 .
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Lisa Deptula opted out of Medicare effective on 01-01-2019 until 01-01-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Secondary Locations
- 2144 4th St Ste A
San Rafael, CA 94901
(415) 390-2060 - 203 Winston Dr
Marshall, MI 49068
(269) 789-1670
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
Student in an Organized Health Care Education/Training Program
- Taxonomy Code
- 390200000X
- Type
- Student, Health Care
- Taxonomy Description
- An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | PA54017 (CA) |
| 2 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 5601006710 (MI) |
Medicare Participation & PECOS Enrollment Status
Lisa Deptula 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
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 01-01-2019
Opt-Out End Date: 01-01-2027
Eligible to Order and Refer? Yes
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
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1184052508, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 52. The final step is to find the difference between that total and the next multiple of ten (60 - 52 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 52 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
SOUTHAVEN, MS 38671
SOUTHAVEN, MS 38671
SOUTHAVEN, MS 38671
SOUTHAVEN, MS 38671
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1184052508, enumerated as an "individual" on October 22, 2013.
The provider is located at 7601 SOUTHCREST PKWY SOUTHAVEN, MS 38671 and the phone number is (662) 772-3607.
Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.