Lake Medical Group, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

LAKE MEDICAL GROUP, LLC

Practice address

14750 NW 77TH CT Ste 304
Miami Lakes, FL 33016-1537

Phone

(305) 507-4400

Fax

(305) 826-2840

NPI assigned

Aug 3, 2024

Organization subpart

No

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

Authorized official

Name

Alfonso Gonzalez

Title

President

Phone

(305) 507-4400

Specialties & licenses 11

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Lake Medical Group, LLC

  • Clinic/Center
  • Miami Lakes, FL
  • NPI 1437448354

  O20200413002545

  Same enrollment

Practitioners 1

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

• Alejandro Ramon Gonzalez Ballagas, DPM

  • Foot & Ankle Surgery Podiatrist
  • Coconut Creek, FL
  • NPI 1417180159
  Medicare reassignment NPD

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

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722643200000",
    "number": "1215767496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14750 NW 77TH CT STE 304",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330161537",
            "telephone_number": "305-507-4400",
            "fax_number": "305-826-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14750 NW 77TH CT STE 304",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330161537",
            "telephone_number": "305-507-4400",
            "fax_number": "305-826-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-507-4400"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lag Services Solutions Corp
• Alberto Luis Lago, BS
• Maria Jose Laguna, APRN, DNP
• Stephania Lairet, MD
• Lake Case Management Services LLC
• Lake Medical Group, LLC
• Lake Medical Services Inc
• Emily Elizabeth Lake, LMFT
• Michelle Christina Lake, LMHC, EDD
• Lakes Ambulatory Surgical Center

• Multi-Specialty Clinic/Center in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; 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.