Lakeside Anesthesia Group LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

LAKESIDE ANESTHESIA GROUP LLC

Practice address

9143 Philips Hwy Ste 515
Jacksonville, FL 32256-1335

Phone

(904) 395-4840

Fax

(904) 306-1351

NPI assigned

Apr 9, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Andrew Weaver

Title

Manager

Phone

(904) 395-7772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lakeside Dental Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Jacksonville, FL
  • NPI 1598483414

  O20240608000202

  Same enrollment

Tax ID family

Lakeside Anesthesia Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lakeside Dental Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Jacksonville, FL
  • NPI 1598483414
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebekah L. Wheatley, MD

  • Pediatric Anesthesiology Physician
  • Jacksonville, FL
  • NPI 1154528743
  Medicare reassignment NPD
• Steven V. Collins, MD

  • Pediatric Anesthesiology Physician
  • Nashville, TN
  • NPI 1093820078

  FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1043063068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 HARTLEY RD STE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322578206",
            "telephone_number": "904-395-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9143 PHILIPS HWY STE 515",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561335",
            "telephone_number": "904-395-4840",
            "fax_number": "904-306-1351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ANESTHESIA GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-395-7772",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Gray Dialysis Center LLC
• Olivia Lake
• Shneequa Lake
• Lakel Residential and Care Services
• Lakeshore Medical Care Center, Inc
• Lakeside Dental Surgery Center LLC
• Lakeside SNF Operations LLC
• Lakeview Health Systems, LLC
• Lakewood Chiropractic Clinic, PA
• Lakewood Dentistry, LLC

• Anesthesiology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Anesthesiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.

Verify at the official NPI Registry.