NPIMap

Organization Active NPI

Lake Hospital System Inc

  • Family Medicine Physician
  • Mentor, OH
National Provider Identifier
1366484818
Registry record updated Sep 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKE HOSPITAL SYSTEM INC
Practice address
6990 Lindsay Dr
#3
Mentor, OH 44060-4981
Phone
(440) 255-7938
Fax
(440) 255-9196
NPI assigned
Jun 11, 2006
Organization subpart
Yes
Parent organization
LAKE HOSPITAL SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2007

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

Authorized official

Name
Mr. Robert Tracz
Title
Chief Financial Officer
Phone
(440) 354-1051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6990 Lindsay Dr
#3
Mentor, OH 44060-4981

Mailing address

PO Box 714328
Columbus, OH 43271-4328
Phone (800) 354-1985

Other identifiers 1

IdentifierTypeStateIssuer
2632548MedicaidOH

Other names 1

  • PrimeHealth Family Practice Mentor Doing business as

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 11

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": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1366484818",
    "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": "800-354-1985",
            "fax_number": "440-350-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6990 LINDSAY DR",
            "address_2": "#3",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604981",
            "telephone_number": "440-255-7938",
            "fax_number": "440-255-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE HOSPITAL SYSTEM, INC.",
        "enumeration_date": "2006-06-11",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "TRACZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "440-354-1051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2632548",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimeHealth Family Practice Mentor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; 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.