Grace Lake

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA221993 Issued in OR

Practice address

930 SW Abbey St
Newport, OR 97365-4820

Phone

(541) 265-2244

NPI assigned

Jul 13, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glake305299@samhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samaritan Pacific Health Services, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Newport, OR
  • NPI 1174888010
  Medicare reassignment
• Samaritan Pacific Health Services Inc

  • Obstetrics & Gynecology Physician
  • Newport, OR
  • NPI 1669529087
  NPD
• Samaritan Pacific Health Services, Inc

  • Rural Health Clinic/Center
  • Depoe Bay, OR
  • NPI 1164781142
  NPD

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1124752233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 SW ABBEY ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973654820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SW ABBEY ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973654820",
            "telephone_number": "541-265-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA221993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glake305299@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "930 SW Abbey St",
            "city": "Newport",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973654820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sue F. Kreul, ANP
• Amber Consuelo Kumar
• Cathy Kwapinski, RN, M.S.
• Ekaterina Kyte
• Lalori Lager
• Trisha Nicole Lakey-Serrano, PSS
• Marie Ann Laper, LCSW
• Capella A Lapham, NP-PP
• Justine Lara Rodriguez, CRM
• Crystal Larimore, CRM

• Physician Assistant in Newport, OR
• Providers in Newport, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.