NPIMap

Organization Active NPI

Lake City Primary Care PLLC

Doing business as Richard a Webber Dba Lake City Primary Care

  • Family Medicine Physician
  • Plattsburgh, NY
National Provider Identifier
1164850053
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
210018 Issued in NY
Legal business name
LAKE CITY PRIMARY CARE PLLC
Doing business as
Richard a Webber Dba Lake City Primary Care
Practice address
16 Degrandpre Way
Suite 300
Plattsburgh, NY 12901-6451
Phone
(518) 561-8256
NPI assigned
Oct 31, 2013
Last updated
Jan 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

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

Authorized official

Name
Ms. Kelley Brault
Title
Office Manager
Phone
(518) 561-8256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 210018 NY Primary
Internal Medicine Physician 207R00000X 210018 NY

Addresses

Primary practice location

16 Degrandpre Way
Suite 300
Plattsburgh, NY 12901-6451

Mailing address

16 Degrandpre Way
Suite 300
Plattsburgh, NY 12901-6451
Phone (518) 561-8256

Other names 1

  • RICHARD A WEBBER DBA LAKE CITY PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140116001465 NY Part B Supplier - Clinic/Group Practice 0143458299 Receives reassigned benefits from 10 practitioners
Practice locations: Plattsburgh, NY

National Provider Directory

National Provider Directory

Locations

16 Degrandpre Way
Ste 300
Plattsburgh, NY 12901
Phone (518) 561-8256

Practitioners & affiliated clinicians

Practitioners 10

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": "1383177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1164850053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 DEGRANDPRE WAY",
            "address_2": "SUITE 300",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016451",
            "telephone_number": "518-561-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 DEGRANDPRE WAY",
            "address_2": "SUITE 300",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016451",
            "telephone_number": "518-561-8256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-31",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "BRAULT",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "518-561-8256",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "210018",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "210018",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICHARD A WEBBER DBA LAKE CITY PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plattsburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; 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.