NPIMap

Organization Active NPI

Lakeforest Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Gaithersburg, MD
National Provider Identifier
1487779435
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1136 Issued in MD
Legal business name
LAKEFOREST AMBULATORY SURGERY CENTER
Practice address
702 Russell Ave
#301
Gaithersburg, MD 20877-2606
Phone
(301) 948-3668
Fax
(301) 926-7787
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michael Lawrence Michetti, DPMNPI 1245220789
Title
President
Phone
(301) 948-3668

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
Ambulatory Surgical Clinic/Center 261QA1903X A1136 MD Primary

Addresses

Primary practice location

702 Russell Ave
#301
Gaithersburg, MD 20877-2606

Mailing address

702 Russell Ave
#301
Gaithersburg, MD 20877-2606
Phone (301) 948-3668

Other identifiers 3

IdentifierTypeStateIssuer
309595OtherMEDICARE PROVIDER #
A1136OtherMDMARYLAND LICENSE
309597OtherMEDICARE PROVIDER # DH

Other names 1

  • District Heights Ambulatory Surgery Center Other name

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Lakeforest Ambulatory Surgery CenterCCN 21C0001136
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

702 Russell Ave
#301
Gaithersburg, MD 20877
Phone (301) 948-3668

Practitioners & affiliated clinicians

Practitioners 1

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": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487779435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 RUSSELL AVE",
            "address_2": "#301",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772606",
            "telephone_number": "301-948-3668",
            "fax_number": "301-926-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 RUSSELL AVE",
            "address_2": "#301",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772606",
            "telephone_number": "301-948-3668",
            "fax_number": "301-926-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEFOREST AMBULATORY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICHETTI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-948-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "309595",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND LICENSE",
            "identifier": "A1136",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER # DH",
            "identifier": "309597",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "District Heights Ambulatory Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.