Edward Lake, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

29465 Issued in WI

Practice address

855 N Westhaven Dr
Oshkosh, WI 54904-7668

Phone

(920) 303-5626

Fax

(920) 303-5632

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

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

NephrologyAlso: Internal Medicine

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Oshkosh West Dialysis Dialysis facility, Oshkosh, WI, CCN 522560
• DaVita Green Lake County Dialysis Dialysis facility, Berlin, WI, CCN 522605
• Fresenius Medical Care Oshkosh Dialysis facility, Oshkosh, WI, CCN 522545
• FMC - Ripon South Dialysis facility, Ripon, WI, CCN 522547
• FMC - Neenah Dialysis facility, Neenah, WI, CCN 522500
• Aurora Medical Ctr Oshkosh Hospital, Oshkosh, WI, CCN 520198
• Thedacare Medical Center - Berlin Inc Hospital, Berlin, WI, CCN 521355

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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bio-Medical Applications of Wisconsin, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Neenah, WI
  • NPI 1093820854

  Dialysis facility

  Care Compare affiliation Name & address match
• Bio-Medical Applications of Wisconsin, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Ripon, WI
  • NPI 1598796682

  Dialysis facility

  Care Compare affiliation Name & address match
• Fresenius Medical Care Oshkosh, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oshkosh, WI
  • NPI 1770040859

  Dialysis facility

  Care Compare affiliation Name & address match
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Oshkosh, WI
  • NPI 1184994030

  Dialysis facility

  Care Compare affiliation Name & address match
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Berlin, WI
  • NPI 1235513912

  Dialysis facility

  Care Compare affiliation Name & address match
• Aurora Medical Center of Oshkosh, Inc

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1275578064
  Care Compare affiliation
• Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Ripon, WI
  • NPI 1326493602
  Care Compare affiliation
• Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Berlin, WI
  • NPI 1760413777
  Care Compare affiliation
• Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Wautoma, WI
  • NPI 1992159289
  Care Compare affiliation

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1336131101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 N WESTHAVEN DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047668",
            "telephone_number": "920-303-5626",
            "fax_number": "920-303-5632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "29465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31925100",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elake43720@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "855 N Westhaven Dr",
            "city": "Oshkosh",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549047668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "855 N Westhaven Dr",
            "city": "Oshkosh",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549047668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kurtti Chiropractic, LLC
• Scott Charles Kurtti, DC
• Adyson Marie Ladd
• Elizabeth A Lahm, PH.D.
• Lake Pointe Senior Living, Inc.
• Lakeshore Manor Memory Care LLC
• Lakeshore Manor Memory Care LLC
• Lakeside Neurocare
• Lakeside Neurocare Limited
• Elisa L Lambie, APNP

• Nephrology Physician in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Nephrology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.