Lakeside Health Clinic, P.C.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LAKESIDE HEALTH CLINIC, P.C.

Practice address

813 E Wood St
Paris, TN 38242-4223

Phone

(731) 924-2000

Fax

(731) 653-0053

NPI assigned

Oct 25, 2012

Last updated

Oct 30, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Hatch Hubbard, PA-C

Title

Owner/PA-C

Phone

(731) 924-2000

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336492495. Details of each certification follow.

• CCN 883845 Rural health clinic · Active · Details

Rural health clinic certification: CCN 883845

Legal name

LAKESIDE HEALTH CLINIC, P.C.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 1, 2021

Last certification

Jun 11, 2026

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Aug 31, 2012 in TN

Enrollment address

813 E Wood St
Paris, TN 38242-4223

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DEAJCD

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Lisa Dianne Hatch Hubbard, P.A.

  • Medical Physician Assistant
  • Paris, TN
  • NPI 1760461016

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 3

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.

• Susan Patricia Dierkes, PA-C

  • Physician Assistant
  • Dresden, TN
  • NPI 1972708402
  Medicare reassignment Care Compare group
• Lisa Dianne Hatch Hubbard, P.A.

  • Medical Physician Assistant
  • Paris, TN
  • NPI 1760461016
  Medicare reassignment Care Compare group
• Monica A. Peeler, MD

  • Family Medicine Physician
  • Miramar, FL
  • NPI 1952507063
  NPD (past)

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1336492495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1269",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382421269",
            "telephone_number": "731-924-2000",
            "fax_number": "731-653-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 E WOOD ST",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424223",
            "telephone_number": "731-924-2000",
            "fax_number": "731-653-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HEALTH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "HATCH",
        "authorized_official_title_or_position": "OWNER/PA-C",
        "authorized_official_telephone_number": "731-924-2000",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530820",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Klingenberg
• Mary Katharine Klopfenstein, OT
• Melinda A Knott, APRN-BC
• Paul D. Koerner, M.D
• Martha Jane Laird, CRNA
• James Lancaster
• Thomas Land
• Christy Leanne Lankford, PA-C
• Drew Lewis
• Lincare Inc. (United Medical)

• Rural Health Clinic/Center in Paris, TN
• Providers in Paris, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.