NPIMap

Organization Active NPI

Lakeside Medical Associates, a Medical Group, Inc.

Doing business as Lakeside Community Healthcare Medical Group

  • Urology Physician
  • Valencia, CA
National Provider Identifier
1487859815
Registry record updated May 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Doing business as
Lakeside Community Healthcare Medical Group
Practice address
25775 McBean Pkwy
Suite 107
Valencia, CA 91355-3708
Phone
(661) 259-9680
Fax
(661) 964-0387
NPI assigned
Jun 16, 2007
Last updated
May 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2009

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

Authorized official

Name
Kerry E. Weiner, M.D.NPI 1528062437
Title
President
Phone
(818) 637-2000

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
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

25775 McBean Pkwy
Suite 107
Valencia, CA 91355-3708

Mailing address

777 Flower St Ste a
Glendale, CA 91201-3000
Phone (818) 637-2000

Other identifiers 1

IdentifierTypeStateIssuer
GR0068388MedicaidCA

Other names 1

  • Lakeside Community Healthcare Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Community Healthcare Medical Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

25775 McBean Pkwy
Ste 107
Valencia, CA 91355
Phone (661) 259-9680

Practitioners & affiliated clinicians

Practitioners 2

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": "1181952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1487859815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST STE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013000",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25775 MCBEAN PKWY",
            "address_2": "SUITE 107",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913553708",
            "telephone_number": "661-259-9680",
            "fax_number": "661-964-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-16",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-637-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068388",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Community Healthcare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; 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.