NPIMap

Organization Active NPI

Lake Erie Medical Group PC

  • Internal Medicine Physician
  • Erie, PA
National Provider Identifier
1053696997
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAKE ERIE MEDICAL GROUP PC
Practice address
2501 W 12TH St Ste C10
Erie, PA 16505-4527
Phone
(814) 580-5600
Fax
(814) 455-2584
NPI assigned
Oct 11, 2011
Last updated
Dec 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Tamara L Hatt
Title
Senior Enrollment Specialist
Phone
(814) 452-5772

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Physical Medicine & Rehabilitation Physician 208100000X NU

Addresses

Primary practice location

2501 W 12TH St Ste C10
Erie, PA 16505-4527

Mailing address

2501 W 12TH St Ste C10
Erie, PA 16505-4527
Phone (814) 580-5600

Other names 1

  • Niagara Internal Medicine Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120117000547 PA Part B Supplier - Clinic/Group Practice 0749457612 Receives reassigned benefits from 23 practitioners
Practice locations: Erie, PA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2501 W 12th St
Ste C10
Erie, PA 16505
Phone (814) 580-5600

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1053696997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST STE C10",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-580-5600",
            "fax_number": "814-455-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST STE C10",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-580-5600",
            "fax_number": "814-455-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ERIE MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "HATT",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "814-452-5772"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.ahn.org",
            "affiliation": "N",
            "address_1": "145 W 23rd St",
            "address_2": "Suite 202",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165022858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Niagara Internal Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.