Active NPI
Lake Hospital System, Inc.
- Orthopaedic Surgery Physician
- Willoughby, OH
National Provider Identifier
1003090689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- LAKE HOSPITAL SYSTEM, INC.
- Practice address
- 36060 Euclid Ave
Suite 203
Willoughby, OH 44094-4656 - Phone
- (440) 602-6670
- Fax
- (440) 602-6671
- NPI assigned
- Dec 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Tracz
- Title
- Chief Financial Officer
- Phone
- (440) 354-1642
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | Primary |
Addresses
Primary practice location
36060 Euclid Ave
Suite 203
Willoughby, OH 44094-4656
Mailing address
P.O. Box 714328
Columbus, OH 43271-4328
Phone (440) 602-6670
Other names 1
- Lake Health Physician Group
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031217000963 | OH | Part B Supplier - Clinic/Group Practice | 6002713922 |
Receives reassigned benefits from 333 practitioners 40 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 39
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- Obstetrics & Gynecology Physician
- Willoughby, OH
- NPI 1346202512
O20031217000963
-
- Clinical Cardiac Electrophysiology Physician
- Willoughby, OH
- NPI 1710295829
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-
- Obstetrics & Gynecology Physician
- Willoughby Hills, OH
- NPI 1699719518
O20031217000963
National Provider Directory
National Provider DirectoryLocations
36060 Euclid Ave
Ste 203
Willoughby, OH 44094
Phone (440) 602-6670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198022400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1302739200000",
"number": "1003090689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 714328",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432714328",
"telephone_number": "440-602-6670",
"fax_number": "440-602-6671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36060 EUCLID AVE",
"address_2": "SUITE 203",
"city": "WILLOUGHBY",
"state": "OH",
"postal_code": "440944656",
"telephone_number": "440-602-6670",
"fax_number": "440-602-6671"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE HOSPITAL SYSTEM, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-12-19",
"last_updated": "2011-04-14",
"status": "A",
"authorized_official_last_name": "TRACZ",
"authorized_official_first_name": "ROBERT",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "440-354-1642"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Lake Health Physician Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Willoughby, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.