NPIMap

Organization Active NPI

Lake Hospital System, Inc.

  • Family Medicine Physician
  • Concord Township, OH
National Provider Identifier
1316198724
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKE HOSPITAL SYSTEM, INC.
Practice address
7580 Auburn Road
Suite 202
Concord Township, OH 44077
Phone
(440) 352-0400
Fax
(440) 352-4535
NPI assigned
Oct 3, 2008
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKE HOSPITAL SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Robert B Tracz
Title
Chief Financial Officer
Phone
(440) 354-1642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

7580 Auburn Road
Suite 202
Concord Township, OH 44077

Mailing address

PO Box 714328
Columbus, OH 43271-4328
Phone (440) 354-1899

Other practice location 1

7580 Auburn Rd Ste 214
Concord Twp, OH 44077-9617
Phone (440) 946-0053

Other identifiers 1

IdentifierTypeStateIssuer
LA9368241OtherOHMEDICARE PTAN

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
Part of
Lake Medical Center

Other organizations with this tax ID 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 8

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": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1316198724",
    "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": "440-354-1899",
            "fax_number": "440-354-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7580 AUBURN ROAD",
            "address_2": "SUITE 202",
            "city": "CONCORD TOWNSHIP",
            "state": "OH",
            "postal_code": "44077",
            "telephone_number": "440-352-0400",
            "fax_number": "440-352-4535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7580 Auburn Rd Ste 214",
            "address_purpose": "LOCATION",
            "city": "Concord Twp",
            "state": "OH",
            "postal_code": "440779617",
            "country_code": "US",
            "telephone_number": "440-946-0053",
            "fax_number": "440-946-1812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE HOSPITAL SYSTEM, INC.",
        "enumeration_date": "2008-10-03",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "TRACZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "440-354-1642"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "LA9368241",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord Township, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.