Physician Compare National (NPI:1265639678)

HEALTHCARE PROVIDER: LISA ANN BLEVINS PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1265639678
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830477546
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161101001309
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLEVINS
	Individual professional last name
Provider First Name	LISA
	Individual professional first name
Provider Middle Name	ANN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	501 MISSION ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 107
	Group Practice or individual's line 2 address
City	SANTA CRUZ
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	950603687
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4086556219
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y