NPIMap

Organization Active NPI

Lakeshore Family Medicine, P.C.

  • Primary Care Clinic/Center
  • Cicero, NY
National Provider Identifier
1124229489
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LAKESHORE FAMILY MEDICINE, P.C.
Practice address
6221 Rte 31
Suite 108
Cicero, NY 13039
Phone
(315) 699-5982
Fax
(315) 699-7221
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Clyde SatterlyNPI 1760428908
Title
MD
Phone
(315) 699-5982

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NY Primary

Addresses

Primary practice location

6221 Rte 31
Suite 108
Cicero, NY 13039

Mailing address

6221 Route 31
Suite 108
Cicero, NY 13039
Phone (315) 699-5982

National Provider Directory

National Provider Directory

Locations

6221 State Route 31
Ste 108
Cicero, NY 13039
Phone (315) 699-5982

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124229489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 ROUTE 31",
            "address_2": "SUITE 108",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "13039",
            "telephone_number": "315-699-5982",
            "fax_number": "315-699-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 RTE 31",
            "address_2": "SUITE 108",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "13039",
            "telephone_number": "315-699-5982",
            "fax_number": "315-699-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE FAMILY MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SATTERLY",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "315-699-5982"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.