NPIMap

Organization Active NPI

Lakeside Medical Associates, a Medical Group, Inc.

Doing business as Lakeside Community Healthcare Medical Group

  • Cardiovascular Disease Physician
  • Glendale, CA
National Provider Identifier
1104001288
Registry record updated May 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Doing business as
Lakeside Community Healthcare Medical Group
Practice address
1500 S Central Ave
Suite 320
Glendale, CA 91204-2530
Phone
(818) 247-3708
Fax
(818) 547-3146
NPI assigned
Jan 8, 2008
Last updated
May 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2009

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

Authorized official

Name
Kerry E. Weiner, M.D.NPI 1528062437
Title
President
Phone
(818) 637-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary

Addresses

Primary practice location

1500 S Central Ave
Suite 320
Glendale, CA 91204-2530

Mailing address

777 Flower St
Suite a
Glendale, CA 91201-3015
Phone (818) 637-2000

Other names 1

  • Lakeside Community Healthcare Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Community Healthcare Medical Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1104001288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST",
            "address_2": "SUITE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013015",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S CENTRAL AVE",
            "address_2": "SUITE 320",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042530",
            "telephone_number": "818-247-3708",
            "fax_number": "818-547-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-637-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Community Healthcare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.