Lakeside Pediatrics, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0420006081 Issued in VT

Legal business name

LAKESIDE PEDIATRICS, PLLC

Practice address

128 Lakeside Ave
Suite 115
Burlington, VT 05401-4939

Phone

(802) 860-1928

Fax

(802) 860-0192

NPI assigned

Apr 13, 2006

Organization subpart

No

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

Authorized official

Name

Lynn Bergeron

Title

Business Office Manager

Phone

(802) 860-1928

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Hagan, Rinehart & Connolly Pediatrics Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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

• Nicholas Robert Bonenfant, M.D.

  • Pediatrics Physician
  • Burlington, VT
  • NPI 1598296725
  NPD (past)
• Melissa Lee Brookman, CPNP

  • Pediatric Nurse Practitioner
  • Burlington, VT
  • NPI 1295505899
  NPD (past)
• Jill Stuart Rinehart, M.D.

  • Pediatrics Physician
  • Burlington, VT
  • NPI 1477500593
  NPD (past)
• Casey Sanner

  • Pediatrics Physician
  • Burlington, VT
  • NPI 1356872493
  NPD (past)
• Tonya Wilkinson, RN, MSN, CPNP

  • Pediatric Nurse Practitioner
  • Burlington, VT
  • NPI 1902815376
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1104880426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LAKESIDE AVE",
            "address_2": "SUITE 115",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054014939",
            "telephone_number": "802-860-1928",
            "fax_number": "802-860-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LAKESIDE AVE",
            "address_2": "SUITE 115",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054014939",
            "telephone_number": "802-860-1928",
            "fax_number": "802-860-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "802-860-1928"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "0420006081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "33869",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "58026HAGA",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007673",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hagan, Rinehart & Connolly Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Timothy Lahey, MD MMSC
• Julie Adams Lahiri, MD
• Thomas Lahiri, M.D.
• Sarah Michael Lake, RN CDE
• Tiffini Jaye Lake, MD
• Taylor Marika Lakusta-Wong, M.D.
• Renick Wells Lalancette, LICSW
• Katie Lam, MD
• Choeden Palmo Lama
• Andrew Lamar

• Pediatrics Physician in Burlington, VT
• Providers in Burlington, VT by specialty
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.