NPIMap

Organization Active NPI

Lakeshore Family Medicine Assoc PC

  • Family Medicine Physician
  • Derby, NY
National Provider Identifier
1295832418
Registry record updated Jul 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
154802 Issued in NY
Legal business name
LAKESHORE FAMILY MEDICINE ASSOC PC
Practice address
7060 Erie Rd
Derby, NY 14047-9306
Phone
(716) 947-0408
Fax
(716) 947-0413
NPI assigned
Sep 20, 2006
Last updated
Jul 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2008

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

Authorized official

Name
Craig K Maclean, DONPI 1588667893
Title
President
Phone
(716) 947-4851

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 154802 NY Primary

Addresses

Primary practice location

7060 Erie Rd
Derby, NY 14047-9306

Mailing address

7060 Erie Rd
Derby, NY 14047-9306
Phone (716) 947-0408

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816000131 NY Part B Supplier - Clinic/Group Practice 8527031988 Receives reassigned benefits from 13 practitioners
Practice locations: Derby, NY; Irving, NY; North Collins, NY

National Provider Directory

National Provider Directory

Locations

7060 Erie Rd
Ste 100
Derby, NY 14047
Phone (716) 947-0408

10626 Main St
North Collins, NY 14111
Phone (716) 337-2422

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1295832418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 ERIE RD",
            "city": "DERBY",
            "state": "NY",
            "postal_code": "140479306",
            "telephone_number": "716-947-0408",
            "fax_number": "716-947-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 ERIE RD",
            "city": "DERBY",
            "state": "NY",
            "postal_code": "140479306",
            "telephone_number": "716-947-0408",
            "fax_number": "716-947-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE FAMILY MEDICINE ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "MACLEAN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-947-4851",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "154802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; 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.