NPIMap

Organization Active NPI

Lake Hospital System, Inc.

Doing business as Lake Health Physician Group Painesville Internal Medicine

  • Internal Medicine Physician
  • Painesville, OH
National Provider Identifier
1265765317
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAKE HOSPITAL SYSTEM, INC.
Doing business as
Lake Health Physician Group Painesville Internal Medicine
Practice address
1223 Mentor Ave
Painesville, OH 44077-1833
Phone
(440) 352-1818
Fax
(440) 352-1895
NPI assigned
Sep 8, 2009
Last updated
Apr 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Richard Cicero
Title
Sr. VP, Business Development
Phone
(440) 354-1739

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1223 Mentor Ave
Painesville, OH 44077-1833

Mailing address

PO Box 714328
Columbus, OH 43271-4328
Phone (440) 352-1818

Other names 1

  • Lake Health Physician Group Painesville Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000963 OH Part B Supplier - Clinic/Group Practice 6002713922 Receives reassigned benefits from 333 practitioners
40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 39

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

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Lake Medical Center37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Locations

1223 Mentor Ave
Painesville, OH 44077
Phone (440) 352-1818

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": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1265765317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 714328",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432714328",
            "telephone_number": "440-352-1818",
            "fax_number": "440-352-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 MENTOR AVE",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440771833",
            "telephone_number": "440-352-1818",
            "fax_number": "440-352-1895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "CICERO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "SR. VP, BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "440-354-1739"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Health Physician Group Painesville Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Painesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.