NPIMap

Organization Active NPI

Lakeside Heart and Lung Center, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Sandusky, OH
National Provider Identifier
1417030982
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
LAKESIDE HEART AND LUNG CENTER, INC.
Practice address
703 Tyler St
Stuite 252
Sandusky, OH 44870-3367
Phone
(419) 609-8000
Fax
(419) 609-8002
NPI assigned
Oct 20, 2006
Last updated
Apr 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Authorized official

Name
Dr. Anthony Deriso II, M.D.NPI 1861459265
Title
Director/ Owner
Phone
(419) 609-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

703 Tyler St
Stuite 252
Sandusky, OH 44870-3367

Mailing address

703 Tyler St
Ste 252
Sandusky, OH 44870-3367
Phone (419) 609-8000

Other identifiers 1

IdentifierTypeStateIssuer
0883469MedicaidOH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1417030982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 TYLER ST",
            "address_2": "STE 252",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448703367",
            "telephone_number": "419-609-8000",
            "fax_number": "419-609-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 TYLER ST",
            "address_2": "STUITE 252",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448703367",
            "telephone_number": "419-609-8000",
            "fax_number": "419-609-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HEART AND LUNG CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "DERISO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR/ OWNER",
        "authorized_official_telephone_number": "419-609-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0883469",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.