Lake Shore Pulmonology, PLC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

4301407127 Issued in MI

Legal business name

LAKE SHORE PULMONOLOGY, PLC

Practice address

17357 Van Wagoner Rd
Suite 2
Spring Lake, MI 49456-9702

Phone

(616) 847-1009

Fax

(616) 847-1607

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Mark James Ivey, M.D.NPI 1962450981

Title

Owner/Physician

Phone

(616) 847-1009

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Mark James Ivey, M.D.

  • Pulmonary Disease Physician
  • Spring Lake, MI
  • NPI 1962450981

  Critical Care Medicine

  Medicare reassignment NPD Authorized official
• Cynthia Lee McNerlin, ANP-BC

  • Adult Health Nurse Practitioner
  • Spring Lake, MI
  • NPI 1336223619
  Medicare reassignment NPD
• Rita Ann Winteringham, PA-C

  • Physician Assistant
  • Muskegon, MI
  • NPI 1013944347
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1245283696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17357 VAN WAGONER RD",
            "address_2": "SUITE 2",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-847-1009",
            "fax_number": "616-847-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17357 VAN WAGONER RD",
            "address_2": "SUITE 2",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-847-1009",
            "fax_number": "616-847-1607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE PULMONOLOGY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "IVEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "616-847-1009",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "4301407127",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MI",
            "license": "4301407127",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "4301407127",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kowalski Counseling
• Kylee M Kowalski, DLLP
• Kristine Koetje Ma, PC
• Kristine Koetje Ma, PC
• Kristine Koetje, Ma LP
• Lakeshore Integrative Health Center PLLC
• Terry Lanigan, LMSW, CFT
• Tonia Joy Lans, LPC
• Gretchen Lawrence, LPC
• Devon Lawrey, MA, CCC-SLP

• Pulmonary Disease Physician in Spring Lake, MI
• Providers in Spring Lake, MI by specialty
• Pulmonary Disease Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.