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DR. LISA MARIE ROTELLI D. O.
NPI 1215953229
Pediatrics in Johnstown, NY

Active since July 14, 2006PECOS Enrolled
110 DECKER DR STE 100, JOHNSTOWN, NY 12095(518) 762-6731(518) 762-7135 Get Directions Write a Review

NPPES record last updated: March 29, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 29, 2021, Oct 22, 2018, Feb 22, 2017 (3 updates tracked since 2017).

About Dr. Lisa Marie Rotelli D. O. NPPES

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

DR. LISA MARIE ROTELLI D. O. (NPI 1215953229) is an individual pediatrics provider in Johnstown, New York, licensed in New York (229169) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of New York College Of Osteo Medicine Of New York Institute Of Technology (1999).

NPPES Registry Identity

NPI1215953229
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. LISA MARIE ROTELLICredential: D. O.
Location Address110 DECKER DR STE 100Johnstown, NY 12095-2157
Mailing Address99 E State StGloversville, NY 12078-1203 · (518) 762-6731 · Fax (518) 762-7135
Phone(518) 762-6731
Fax(518) 762-7135
Sole ProprietorNo
Medical School CMSNew York College Of Osteo Medicine Of New York Institute Of TechnologyGraduated 1999
Enumeration DateJuly 14, 2006
Last NPPES UpdateMarch 29, 20213 updates tracked since enumeration
NPPES CertifiedMarch 29, 2021
✔ NPI 1215953229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in NY · 229169✔ Licensed in AL · DO-901
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedGeneral PracticeTaxonomy 208D00000X · License 229169 (NY)
110 DECKER DR STE 100, Johnstown, NY 12095
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Mountain Health CO-OP, Providence Health Plan, Wellmark of South Dakota, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Lisa Marie Rotelli D. O. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234159922
PECOS Enrollment IDI20260302002790, I20260402002603
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.

Medicare Billing Reassignments

4

Medicare enrollment records show Lisa Rotelli reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Brookview Medical Associates, PLLC
168 mi
General Practice
80 ORVILLE DR STE 100
Bohemia, NY 11716
  • Reassigned Medicare billing, New York enrollment
  • 754 clinicians in this Medicare group
NPI 1871965855 (972) 715-3800
Avera Medical Group Webster
1,159 mi
Family Medicine
401 E HIGHWAY 12 STE 2
Webster, SD 57274
  • Reassigned Medicare billing, South Dakota enrollment
  • Medicare enrollment name: Avera St Lukes
  • 259 clinicians in this Medicare group
NPI 1588978423 (605) 345-2222
Scl Health Medical Group-Butte LLC
1,858 mi
Rural Health
214 S MAIN ST
Boulder, MT 59632
  • Reassigned Medicare billing, Montana enrollment
  • 278 clinicians in this Medicare group
NPI 1861031122 (406) 225-4201
Tuba City Regional Health Care Corporation
1,986 mi
Family Medicine
10 MILES NE OF SR264 MP362, ROCKY RIDGE SCHOOL STREET
Kykotsmovi, AZ 86039
  • Reassigned Medicare billing, Texas enrollment
  • 540 clinicians in this Medicare group
NPI 1396921870 (928) 283-2781

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 12095 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
$84.93 typical visit price
range $54.87 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
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

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

MRS. BETINA G COURTENS FNP-BC
Nurse Practitioner (Family)
110 DECKER DR STE 100
JOHNSTOWN, NY 12095
Fulton County (518) 571-4200

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 Lisa Rotelli's NPI number?

The NPI number for Lisa Rotelli is 1215953229. It was assigned to this individual provider in the NPPES registry on July 14, 2006.

Where is Lisa Rotelli located?

Lisa Rotelli practices at 110 Decker Dr Ste 100, Johnstown, NY 12095. The listed phone number is (518) 762-6731.

What is Lisa Rotelli's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Lisa Rotelli enrolled in Medicare?

Yes. Lisa Rotelli is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Lisa Rotelli's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lisa Rotelli reassigns Medicare benefits to 4 organizations: Brookview Medical Associates, PLLC (Bohemia, NY), Avera Medical Group Webster (Webster, SD), Scl Health Medical Group-Butte LLC (Boulder, MT) and Tuba City Regional Health Care Corporation (Kykotsmovi, AZ). Each 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 Lisa Rotelli's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Lisa Rotelli accept?

Health plans from Mountain Health CO-OP, Providence Health Plan and Wellmark of South Dakota, Inc. list Lisa Rotelli 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.

When was this NPI record last updated?

The NPPES record for Lisa Rotelli was last updated on March 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.