NPIMap

Organization Active NPI

Lakeside Comprehensive Rehabilitation Inc.

  • Physical Therapy Clinic/Center
  • Hart, MI
National Provider Identifier
1396779542
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
LAKESIDE COMPREHENSIVE REHABILITATION INC.
Practice address
601 E Main St
Hart, MI 49420-1144
Phone
(231) 873-3577
Fax
(231) 873-3557
NPI assigned
Jul 11, 2006
Last updated
Mar 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Authorized official

Name
Mrs. Deborah Windell, O.T.R.LNPI 1316010010
Title
Owner/O.T.R.L
Phone
(231) 873-3577

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X MI Primary

Addresses

Primary practice location

601 E Main St
Hart, MI 49420-1144

Mailing address

601 E Main St
Hart, MI 49420-1144
Phone (231) 873-3577

Other identifiers 4

IdentifierTypeStateIssuer
0007770495OtherMIAETNA PIN
650F410300OtherMIBCBSM PIN
177403453814OtherMIHUMANA ID
0704110OtherMIUNITED HEALTHCARE GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140512002091 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3274439443 Receives reassigned benefits from 4 practitioners
Practice locations: Hart, MI

National Provider Directory

National Provider Directory

Locations

601 E Main St
Hart, MI 49420
Phone (231) 873-3557

3336 S Pioneer Pkwy
Ste 301
West Valley City, UT 84120
Phone (801) 964-3865

3336 S Pioneer Pkwy
Ste 306
West Valley City, UT 84120
Phone (801) 840-9474

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1396779542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E MAIN ST",
            "city": "HART",
            "state": "MI",
            "postal_code": "494201144",
            "telephone_number": "231-873-3577",
            "fax_number": "231-873-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E MAIN ST",
            "city": "HART",
            "state": "MI",
            "postal_code": "494201144",
            "telephone_number": "231-873-3577",
            "fax_number": "231-873-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE COMPREHENSIVE REHABILITATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "WINDELL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER/O.T.R.L",
        "authorized_official_telephone_number": "231-873-3577",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.T.R.L"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "0007770495",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "650F410300",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA ID",
            "identifier": "177403453814",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE GROUP #",
            "identifier": "0704110",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hart, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.