Piave Pitisci Lake, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

22627 Issued in SC

Practice address

115 Fairchild St Ste 170
Daniel Island, SC 29492-7602

Phone

(803) 339-1563

Fax

(803) 746-7902

NPI assigned

Mar 1, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Tulane University School of Medicine, 1997

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

DJB MD LLCGroup PAC ID 8325467384, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DJB MD LLC

  dba Bridges Psychiatry Associates

  • Psychiatry Physician
  • Daniel Island, SC
  • NPI 1366941148
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1316075203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 FAIRCHILD ST STE 170",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294927602",
            "telephone_number": "803-339-1563",
            "fax_number": "803-746-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 FAIRCHILD ST STE 170",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294927602",
            "telephone_number": "803-339-1563",
            "fax_number": "803-746-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "PIAVE",
        "middle_name": "PITISCI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "22627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bridgespsychiatry.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "115 Fairchild St Ste 170",
            "city": "Daniel Island",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294927602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bridgespyshciatry.com",
            "affiliation": "N",
            "address_1": "115 Fairchild St Ste 170",
            "city": "Daniel Island",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294927602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatry Physician in Daniel Island, SC
• Providers in Daniel Island, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.