NPIMap

Organization Active NPI

Lakeside Orthopedic Institute LLC

  • Orthopaedic Surgery Physician
  • Lake Havasu City, AZ
National Provider Identifier
1275564916
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
LAKESIDE ORTHOPEDIC INSTITUTE LLC
Practice address
1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648
Phone
(928) 855-1444
NPI assigned
Jul 5, 2006
Last updated
May 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Authorized official

Name
Daniel Edward Heiner, MDNPI 1841270873
Title
Managing Partner
Phone
(928) 505-5555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 23186 AZ
Orthopaedic Surgery Physician 207X00000X 13802 AZ
Orthopaedic Surgery Physician 207X00000X 26379 AZ
Orthopaedic Surgery Physician 207X00000X 34564 AZ
Orthopaedic Surgery Physician 207X00000X Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 0554 AZ
Physical Therapist 225100000X 2641 AZ
Physical Therapist 225100000X 6762 AZ
Physical Therapist 225100000X 8192 AZ

Addresses

Primary practice location

1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648

Mailing address

1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648
Phone (928) 855-4248

Other identifiers 1

IdentifierTypeStateIssuer
DF0357OtherAZMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060918000307 AZ Part B Supplier - Clinic/Group Practice 1052316445 Receives reassigned benefits from 14 practitioners
9 other NPIs on this enrollment
Practice locations: Quartzite, AZ; Lake Havasu City, AZ; Bullhead City, AZ

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1275564916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035648",
            "telephone_number": "928-855-4248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035648",
            "telephone_number": "928-855-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ORTHOPEDIC INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "HEINER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "928-505-5555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "23186",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "13802",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "26379",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "34564",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0554",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "2641",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6762",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8192",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DF0357",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; 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.