Lista Marie Dallis
NPI 1104468610ActiveIndividual· Nurse Practitioner, Family· Tahlequah, OK
Nurse Practitioner, Family with Northeastern Oklahoma Community Health Centers, Inc, practicing in Tahlequah, Oklahoma. Their prescriptions cost Medicare Part D more than their services did: $192,514 for 2,482 claims, against $2,519 paid for services in 2024. Lists Northeastern Health System as a hospital affiliation.
Overview
| NPI | 1104468610 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Oct 16, 2019 |
| Last updated in NPPES | Feb 17, 2022 |
| Certified by provider | Feb 17, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | 99753 | OK |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (OK) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 62 |
|---|---|
| Services billed | 203 across 13 procedure codes |
| Paid by Medicare | $2,519 |
Part D prescriptions in 2024
| Prescriptions (claims) | 2,482 · 5,468 30-day fills |
|---|---|
| Patients | 217 |
| Total drug cost | $192,514 |
| Generic share | 87% of claims |
Education and affiliations
| Graduation year | 2019 |
|---|---|
| Medicare specialty | Nurse Practitioner |
Medical group
- Northeastern Oklahoma Community Health Centers, IncHulbert, OK · 36 clinicians
Hospital affiliation
- Northeastern Health SystemTahlequah, OK
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 35 family nurse practitioners in Tahlequah · All family nurse practitioners in Oklahoma