NPIMap

Organization Active NPI

Lakeside Orthopedic Institute, LLC

  • Family Medicine Physician
  • Lake Havasu City, AZ
National Provider Identifier
1356099790
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKESIDE ORTHOPEDIC INSTITUTE, LLC
Practice address
1720 Mesquite Ave Ste 100
Lake Havasu City, AZ 86403-5602
Phone
(928) 505-5555
Fax
(928) 505-5557
NPI assigned
Mar 15, 2022
Organization subpart
Yes
Parent organization
LAKESIDE ORTHOPEDIC INSTITUTE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Authorized official

Name
Daniel Edward HeinerNPI 1841270873
Title
Authorized Official
Phone
(928) 505-5555

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1720 Mesquite Ave Ste 100
Lake Havasu City, AZ 86403-5602

Mailing address

25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone (928) 505-5555

Other practice location 1

2035 Mesquite Ave Ste C
Lake Havasu City, AZ 86403-5894
Phone (928) 505-5555

Other names 1

  • Lakeside Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060918000307 AZ Part B Supplier - Clinic/Group Practice 1052316445 Receives reassigned benefits from 14 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quartzite, AZ; Lake Havasu City, AZ; Bullhead City, AZ

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Silver State Surgery Center

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776816000000",
    "number": "1356099790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 RIVIERA BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035694",
            "telephone_number": "928-505-5555",
            "fax_number": "928-505-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 MESQUITE AVE STE 100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035602",
            "telephone_number": "928-505-5555",
            "fax_number": "928-505-5557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2035 Mesquite Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Lake Havasu City",
            "state": "AZ",
            "postal_code": "864035894",
            "country_code": "US",
            "telephone_number": "928-505-5555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE ORTHOPEDIC INSTITUTE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE ORTHOPEDIC INSTITUTE, LLC",
        "enumeration_date": "2022-03-15",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A",
        "authorized_official_last_name": "HEINER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "928-505-5555"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeside Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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.