DR. LISA DEETTE STABER MD NPI 1629035308

NPI Information

  • NPI: 1629035308
  • Provider Name: DR. LISA DEETTE STABER, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 20635 MISHAWAKA SHORES TRL
    GRAND RAPIDS, MN
    ZIP 55744
  • Phone: (218) 398-0256

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NPI Details

DR. Lisa Deette Staber, MD is a family medicine in Grand Rapids, MN with 39 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Lisa Deette Staber, MD NPI is 1629035308. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: SANFORD SCHOOL OF MEDICINE OF UNIVERSITY OF SOUTH DAKOTA
Graduation Year:1987

The provider's business location address is:

20635 MISHAWAKA SHORES TRL
GRAND RAPIDS, MN
ZIP 55744-071
Phone: (218) 398-0256

The NPI 1629035308 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Follow-up hospital inpatient care per day, typically 25 minutes (HCPCS:99232)
  • Follow-up hospital inpatient care per day, typically 15 minutes (HCPCS:99231)

The enumeration date for this NPI number is 4/27/2006 and was last updated on 5/9/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine38751-20WISCONSINNo
2207Q00000XFamily Medicine38922MINNESOTAYes
3207Q00000XFamily Medicine38751-020WISCONSINNo
4207Q00000XFamily Medicine4301086765MICHIGANNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P00328166OTHERMICHIGANRR-MEDICARE
2N41200006MEDICARE PIN
34848740MEDICAIDMICHIGAN
4P00328166OTHERRR-MEDICARE
5F80212MEDICARE UPINMICHIGAN
64825080002MEDICARE NSCMICHIGAN
7F80212MEDICARE UPIN
84825080002MEDICARE NSC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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