NPIMap

Organization Active NPI

Lakeshore Area Radiation Oncology Center

  • Radiation Oncology Clinic/Center
  • Holland, MI
National Provider Identifier
1295820900
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
Legal business name
LAKESHORE AREA RADIATION ONCOLOGY CENTER
Practice address
12642 Riley St
Holland, MI 49424-9202
Phone
(616) 355-3876
Fax
(616) 786-0255
NPI assigned
Oct 4, 2006
Last updated
Jun 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

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

Authorized official

Name
Mr. Ryan Powers
Title
Executive Director
Phone
(616) 772-7513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X Primary

Addresses

Primary practice location

12642 Riley St
Holland, MI 49424-9202

Mailing address

12642 Riley St
Holland, MI 49424-9202
Phone (616) 355-3876

Other identifiers 2

IdentifierTypeStateIssuer
002827OtherMIPRIORITY HEALTH
32-0-G0-1091-0OtherMIBCBSM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000102 MI Part B Supplier - Radiation Therapy Center 7214828334 Practice locations: Holland, MI

National Provider Directory

National Provider Directory

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

Locations

12642 Riley St
Holland, MI 49424
Phone (616) 355-3976

Practitioners & affiliated clinicians

Practitioners 11

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434326400000",
    "number": "1295820900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12642 RILEY ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494249202",
            "telephone_number": "616-355-3876",
            "fax_number": "616-786-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12642 RILEY ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494249202",
            "telephone_number": "616-355-3876",
            "fax_number": "616-786-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE AREA RADIATION ONCOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2015-06-15",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-772-7513",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "002827",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "32-0-G0-1091-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; 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.