Lake County Pain & Diagnostic

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0743A5 Issued in OH

Legal business name

LAKE COUNTY PAIN & DIAGNOSTIC

Practice address

8401 Mentor Ave
Ste a
Mentor, OH 44060-5842

Phone

(440) 205-9119

Fax

(440) 205-9209

NPI assigned

Sep 14, 2005

Organization subpart

Yes

Parent organization

PATRICK T. BOYLAN, MD INCAs reported in NPPES

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

Authorized official

Name

Patrick T Boylan, MDNPI 1386669810

Title

Owner / Physician

Phone

(440) 205-9119

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497740617. Details of each certification follow.

• CCN 36C0001198 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 36C0001198

Legal name

LAKE COUNTY PAIN & DIAGNOSTIC CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Feb 9, 2005

Last certification

May 25, 2017

Ownership / control type

Proprietary

Facility address

8401 Mentor Avenue, Suite a
Mentor, OH 44060

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Patrick T Boylan MD Inc

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9715/brand/2/csg/1/fhir/r4

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Patrick T Boylan MD Inc

  dba Lake Physical Medicine

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Mentor, OH
  • NPI 1760884399
  NPPES parent name

Practitioners 1

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.

• Patrick T Boylan, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Mentor, OH
  • NPI 1386669810
  NPD Authorized official

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1497740617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE STE 203",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608723",
            "telephone_number": "440-205-9119",
            "fax_number": "440-205-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MENTOR AVE",
            "address_2": "STE A",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605842",
            "telephone_number": "440-205-9119",
            "fax_number": "440-205-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY PAIN & DIAGNOSTIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATRICK T. BOYLAN, MD INC",
        "enumeration_date": "2005-09-14",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "BOYLAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER / PHYSICIAN",
        "authorized_official_telephone_number": "440-205-9119",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0743A5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Family Practice, LLC
• Lake County Foot & Ankle Associates, LLC
• Lake County Foot & Ankle Associates, LLC
• Lake County Foot & Ankle Associates, LLC (Foot & Ankle Specialists of Ohio, LLC)
• Lake County Internal Medicine, Inc.
• Lake County Pediatric Speech & Language Therapy, LLC
• Lake Health-University Hospitals Seidman Cancer Center
• Lake Health-University Hospitals Seidman Cancer Center
• Lake Health-University Hospitals Seidman Cancer Ctr Physicians Inc
• Lake Hospital System (LHPG Thomas Mentor Family Practice)

• Ambulatory Surgical Clinic/Center in Mentor, OH
• Providers in Mentor, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.