NPIMap

Organization Active NPI

Lakeland Medical Practices

  • Audiologist
  • Niles, MI
National Provider Identifier
1134898505
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
LAKELAND MEDICAL PRACTICES
Practice address
42 N Saint Joseph Ave Ste 300
Niles, MI 49120-2203
Phone
(269) 687-2910
NPI assigned
Sep 9, 2021
Last updated
Aug 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

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

Authorized official

Name
Paul Konopacki
Title
Finance, VP
Phone
(616) 486-9305

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 231H00000X Primary
Audiologist-Hearing Aid FitterGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 237600000X
Hearing Aid Equipment 332S00000X

Addresses

Primary practice location

42 N Saint Joseph Ave Ste 300
Niles, MI 49120-2203

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090928000216 MI Part B Supplier - Clinic/Group Practice 1658427042 Receives reassigned benefits from 798 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Joseph, MI; Stevensville, MI; Buchanan, MI; Niles, MI; Coloma, MI; Bridgman, MI; Berrien Springs, MI; Benton Harbor, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Medical Practice49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1134898505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 N SAINT JOSEPH AVE STE 300",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202203",
            "telephone_number": "269-687-2910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "KONOPACKI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "FINANCE, VP",
        "authorized_official_telephone_number": "616-486-9305"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.