NPIMap

Individual provider Active NPI

Thomas Rosser Lake III, MD

  • Colon & Rectal Surgery Physician
  • Oakhurst, NJ
National Provider Identifier
1003881277
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
25MA07084700 Issued in NJ
Practice address
255 Monmouth Rd
Oakhurst, NJ 07755-1515
Phone
(732) 531-5445
Fax
(732) 531-1776
NPI assigned
Feb 21, 2006
Last updated
Feb 4, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 25MA07084700 NJ Primary

Addresses

Primary practice location

255 Monmouth Rd
Oakhurst, NJ 07755-1515

Mailing address

255 Monmouth Rd
Oakhurst, NJ 07755-1515
Phone (732) 531-5445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110310000171 NJ Practitioner - Colorectal Surgery (Proctology) 3173537727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (551) 996-5045

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy118
Removal of tissue17
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA07084700NJMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Sep 1, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Sep 1, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Past Accepting new patients
HMH Hospitals Corporation PastSince Jan 1, 2018 Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

255 Monmouth Rd
Oakhurst, NJ 07755
Phone (732) 531-5445

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hackensack University Medical Center - Psychiatric UnitHackensack, NJ, CCN 31S001 Hospital Corporate Director Jan 1, 2018
Hackensack University Medical CenterHackensack, NJ, CCN 310001 Hospital Corporate Director Jan 1, 2018
Riverview Medical CenterRed Bank, NJ, CCN 310034 Hospital Corporate Director Jan 1, 2024
Bayshore Medical CenterHolmdel, NJ, CCN 310112 Hospital Corporate Director Jan 1, 2023
Ocean University Medical CenterBrick, NJ, CCN 310052 Hospital Corporate Director Jan 1, 2018
Jersey Shore University Medical CenterNeptune, NJ, CCN 310073 Hospital Corporate Director Jan 1, 2018
Southern Ocean Medical CenterManahawkin, NJ, CCN 310113 Hospital Corporate Director Jan 1, 2018
Palisades Medical CenterNorth Bergen, NJ, CCN 310003 Hospital Corporate Director Jan 1, 2023
Raritan Bay Medical CenterPerth Amboy, NJ, CCN 310039 Hospital Corporate Director Jan 1, 2018
Johnson Rehabilitation Institute at Riverview Medical CenterRed Bank, NJ, CCN 31T034 Hospital Corporate Director Jan 1, 2018
Jersey Shore University Medical CenterNeptune, NJ, CCN 31S073 Hospital Corporate Director Jan 1, 2023
Johnson Rehabilitation Institute at Ocean Medical CenterBrick, NJ, CCN 31T052 Hospital Corporate Director Jan 1, 2018
JFK University Medical CenterEdison, NJ, CCN 310108 Hospital Corporate Director Jan 1, 2023
JFK Johnson Rehabilitation InstituteEdison, NJ, CCN 31T108 Hospital Corporate Director Jul 1, 2021

Owned or controlled facilities with NPI records 23

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 23

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1003881277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 MONMOUTH RD",
            "city": "OAKHURST",
            "state": "NJ",
            "postal_code": "077551515",
            "telephone_number": "732-531-5445",
            "fax_number": "732-531-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 MONMOUTH RD",
            "city": "OAKHURST",
            "state": "NJ",
            "postal_code": "077551515",
            "telephone_number": "732-531-5445",
            "fax_number": "732-531-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "THOMAS",
        "middle_name": "ROSSER",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "NJ",
            "license": "25MA07084700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakhurst, NJ

Sources for this page

Verify at the official NPI Registry.