Lake Shore Hma Medical Group LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

LAKE SHORE HMA MEDICAL GROUP LLC

Practice address

348 NE Methodist Ter Ste 104
Lake City, FL 32055-3408

Phone

(386) 292-8024

NPI assigned

May 27, 2010

Organization subpart

No

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

Authorized official

Name

James P Wright

Title

VP Physician Business Services

Phone

(615) 778-1502

Specialties & licenses 9

Addresses

Locations

Practitioners 6

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.

• Glenn Steven Avidon, M.D.

  • Anesthesiology Physician
  • Deland, FL
  • NPI 1124138292
  NPD (past)
• Tohmina Begum, M.D

  • Internal Medicine Physician
  • Boynton Beach, FL
  • NPI 1366680357
  NPD (past)
• Jack E Cohen, DO

  • Orthopaedic Surgery Physician
  • Orange Park, FL
  • NPI 1720084577
  NPD (past)
• Bilal Khodr, M.D.

  • Pediatrics Physician
  • Gainesville, FL
  • NPI 1881653723

  Family Medicine

  NPD (past)
• Bryan Rodger Prine Jr., MD

  • Sports Medicine (Family Medicine) Physician
  • Ocala, FL
  • NPI 1447330535
  NPD (past)
• Timothy Albert Lane, M.D.

  • Anesthesiology Physician
  • Montauk, NY
  • NPI 1104093962
  NPD (past)

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557878400000",
    "number": "1215256458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 NE METHODIST TER STE 104",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320553408",
            "telephone_number": "386-292-8024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE HMA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2019-05-15",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP PHYSICIAN BUSINESS SERVICES",
        "authorized_official_telephone_number": "615-778-1502"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake City Surgery Center, LLC
• Lake City Veteran's Hospital
• Lake City Vision PA
• Lake Citytherapeutic LLC
• Lake Shore Center for Aesthetics & Plastic Surgery PA
• Lake Shore Hma, LLC (Shands Lake Shore Regional Medical Center)
• Lake Shore Hma, LLC (Shands Lake Shore Regional Medical Center)
• Vasu Nagaraju Lakkimsetti, M.D.,
• Anthony R Lambert, PA-C
• Paula Lamon, ARNP

• Surgery Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; 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.