LISSETTE ALEXANDRA OTERO NP
NPI 1255037065
Nurse Practitioner - Adult Health in New York, NY

Q: What is Lissette Otero's NPI number?

The NPI number for Lissette Otero is 1255037065. It was assigned to this individual provider in the NPPES registry on February 2, 2023.

Q: What is Lissette Otero's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Lissette Otero was last updated on April 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since February 02, 2023PECOS EnrolledAccepts Medicare Assignment

4405 BROADWAY, NEW YORK, NY 10040(212) 740-2020(646) 666-0280 Get Directions Write a Review

NPPES record last updated: April 13, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 13, 2026, Feb 2, 2023 (2 updates tracked since 2023).

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About Lissette Alexandra Otero Np NPPES

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

LISSETTE ALEXANDRA OTERO NP (NPI 1255037065) is an individual adult health provider in New York, New York, licensed in New York (311049) and active in the NPI registry since February 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in New York, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1255037065

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameLISSETTE ALEXANDRA OTEROCredential: NP

Location Address4405 BROADWAYNew York, NY 10040-4014

Mailing AddressPo Box 746087Atlanta, GA 30374-6087 · (773) 352-1515

Phone(212) 740-2020

Fax(646) 666-0280

Sole ProprietorYes

Medical School CMSOtherGraduated 2022

Enumeration DateFebruary 2, 2023

Last NPPES UpdateApril 13, 20262 updates tracked since enumeration

NPPES CertifiedApril 13, 2026

✔ NPI 1255037065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

License✔ Licensed in NY · 311049

4405 BROADWAY, New York, NY 10040

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Secondary Practice Location 1

Location 1161 E 91st St Apt 4ANew York, NY 10128-2019 · Phone (203) 818-3741

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

Lissette Alexandra Otero Np 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 ID6507212206

PECOS Enrollment IDI20231101002534

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 2

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.

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

27 services21 patients

Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes 99348

An established patient home visit is a 25-minute appointment where a healthcare provider visits you at your home. This service is for patients who have previously been seen by the provider. It includes a check-up and discussion about your health concerns.

25 services17 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10040 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

$102.04 typical visit price

range $65.69 – $198.19

Typical copayment $25.51 (range $16.42 – $49.54)

Most-billed visit code 99203

Established Patient

$114.88 typical visit price

range $21.20 – $160.66

Typical copayment $28.72 (range $5.30 – $40.16)

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.

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Other Providers at the Same Location NPPES 20

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

DR. MARK AARON JACKNIN D.O.

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