Lake Superior State University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKE SUPERIOR STATE UNIVERSITY

Practice address

650 W Easterday Ave
Sault Sainte Marie, MI 49783-1656

Phone

(906) 635-2110

NPI assigned

Aug 12, 2005

Organization subpart

No

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

Authorized official

Name

Kenneth Peress, PHD

Title

Vice President Student Affairs

Phone

(906) 635-2634

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

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

• Abigail Berke Parker, NP

  • Nurse Practitioner
  • Sault Sainte Marie, MI
  • NPI 1699503524
  Medicare reassignment Care Compare group NPD
• Erin Meehan-Amo, PA-C

  • Physician Assistant
  • Sault Sainte Marie, MI
  • NPI 1699199547
  Medicare reassignment Care Compare group
• Jonathan Sommers, NP-C

  • Family Nurse Practitioner
  • Kincheloe, MI
  • NPI 1982010864
  Medicare reassignment NPD
• Scott Michael Bartz, PA-C

  • Medical Physician Assistant
  • Sault Sainte Marie, MI
  • NPI 1285739912
  Medicare reassignment
• Joseph D. Susi II, MS, ATC

  • Athletic Trainer
  • Sault Sainte Marie, MI
  • NPI 1912056201
  NPD (past)

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1467454199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W EASTERDAY AVE",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831656",
            "telephone_number": "906-635-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W EASTERDAY AVE",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831656",
            "telephone_number": "906-635-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-12",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "PERESS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VICE PRESIDENT STUDENT AFFAIRS",
        "authorized_official_telephone_number": "906-635-2634",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Labadie
• Sarah Lackey, RN
• Jeanette Laffy, M.S., CCC-SLP
• Kerry Ann Laitinen
• Lake County Physical Medicine PLLC
• Lakeview Internal Medicine,P.C
• Lisa Marie Lalonde, MSW
• Lorraine Mavis Land
• Shawn Elise Lange I, COTA
• Chelsee Larsen, OTRL

• Family Medicine Physician in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.