Integrative Medicine Lake Country, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

INTEGRATIVE MEDICINE LAKE COUNTRY, LLC

Practice address

138 North Ave Ste 4
Hartland, WI 53029-1725

Phone

(262) 256-3020

NPI assigned

Dec 4, 2024

Organization subpart

No

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

Authorized official

Name

Jamie Kaminski, FNPNPI 1568074359

Title

Owner, Nurse Practitioner

Phone

(262) 256-3020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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

• Jamie L Kaminski

  • Nurse Practitioner
  • West Allis, WI
  • NPI 1568074359
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1235945346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 NORTH AVE STE 4",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291725",
            "telephone_number": "262-256-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 NORTH AVE STE 4",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291725",
            "telephone_number": "262-256-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MEDICINE LAKE COUNTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "KAMINSKI",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "OWNER, NURSE PRACTITIONER",
        "authorized_official_telephone_number": "262-256-3020",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Hartland, WI
• Providers in Hartland, WI by specialty
• Medical Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.