DR. LISA DEETTE STABER MD
NPI 1629035308
Family Medicine in Grand Rapids, MN
About Dr. Lisa Deette Staber Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. LISA DEETTE STABER MD (NPI 1629035308) is an individual family medicine provider in Grand Rapids, Minnesota, licensed in Minnesota (38922) and active in the NPI registry since April 2006. She is enrolled in Medicare PECOS, is affiliated with Avera Granite Falls, and is a graduate of Sanford School Of Medicine Of University Of South Dakota (1987).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 8
Accepted 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 Deette Staber Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Lisa Staber reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Granite Falls, MN 56241
- Reassigned Medicare billing, Minnesota enrollment
- Also billed through NPI 1700429644 (Minnesota)
- 66 clinicians in this Medicare group
Ivanhoe, MN 56142
- Reassigned Medicare billing, Minnesota enrollment
- 52 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.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Avera Granite Falls
Critical Access Hospitals · Granite Falls, MNAvera Tyler Hospital
Critical Access Hospitals · Tyler, MNAvera Marshall Regional Medical Ctr
Critical Access Hospitals · Marshall, MNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55744 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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 Staber's NPI number?
The NPI number for Lisa Staber is 1629035308. It was assigned to this individual provider in the NPPES registry on April 27, 2006.
Where is Lisa Staber located?
Lisa Staber practices at 20635 Mishawaka Shores Trl, Grand Rapids, MN 55744. The listed phone number is (218) 398-0256.
What is Lisa Staber's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lisa Staber enrolled in Medicare?
Yes. Lisa Staber is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Lisa Staber's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Lisa Staber reassigns Medicare benefits to 2 organizations: Avera Granite Falls (Granite Falls, MN) and Avera Tyler (Ivanhoe, MN). 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 Staber's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Lisa Staber accept?
Health plans from Avera Health Plans and Sanford Health Plan list Lisa Staber 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 Lisa Staber affiliated with any hospitals?
According to CMS data, Lisa Staber is affiliated with Avera Granite Falls, Avera Tyler Hospital and Avera Marshall Regional Medical Ctr.
When was this NPI record last updated?
The NPPES record for Lisa Staber was last updated on May 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Dr. Lisa Deette Staber, MD · NPI 1629035308
Family Medicine physician in Grand Rapids, Minnesota. Individual provider, active in the CMS NPPES registry since April 27, 2006.
## Identity
- **NPI:** 1629035308 (Entity type: Individual)
- **Enumerated:** April 27, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 38922 (Minnesota)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 20635 MISHAWAKA SHORES TRL, Grand Rapids, MN 55744-6071
- **Phone:** (218) 398-0256
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Avera Granite Falls (NPI 1700429610, Granite Falls, MN); Avera Tyler (NPI 1063949089, Ivanhoe, MN) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Sanford School Of Medicine Of University Of South Dakota, class of 1987
## Record status
- **NPPES last updated:** May 9, 2017
- **Other identifiers:** Other P00328166 (MI); Medicare PIN N41200006; Medicaid 4848740 (MI); and 5 more
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Source: [NPI Profile](https://npiprofile.com/npi/1629035308) · Data from the CMS NPPES public registry.