Lakeside Ambulatory Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

LAKESIDE AMBULATORY SURGICAL CENTER LLC

Practice address

17030 Lakeside Hills PLZ Ste 110
Omaha, NE 68130-2440

Phone

(402) 758-5120

Fax

(402) 758-5087

NPI assigned

May 3, 2006

Organization subpart

No

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

Authorized official

Name

Alicia K Wagner

Title

Ceo

Phone

(402) 758-5212

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Listed as

Lakeside Ambulatory Surgical Center LLCCCN 28C0001040

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Alegent Creighton Health

  • Body Imaging Physician
  • Omaha, NE
  • NPI 1417975483

  Member Of

  NPD member
• Gross, Iwersen, Kratochvil & Klein MD PC

  • Durable Medical Equipment & Medical Supplies
  • Bellevue, NE
  • NPI 1396116539

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1528026788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17030 LAKESIDE HILLS PLZ STE 110",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302440",
            "telephone_number": "402-758-5120",
            "fax_number": "402-758-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17030 LAKESIDE HILLS PLZ STE 110",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302440",
            "telephone_number": "402-758-5120",
            "fax_number": "402-758-5087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE AMBULATORY SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-758-5212"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsy Lynn Lairmore, LPN
• Claire Renee Lakatos-Rathjen, DPT
• Daniel J Lake
• Jay Lake, CRNA
• Stephanie Louise Lake, D.D.S.
• Lakeside Chiropractic Specialists
• Lakeside Ear, Nose, & Throat Physicians, PC
• Lakeside Endoscopy Center LLC
• Lakeside Orthopedics PC
• Lakeside Orthopedics, PC.

• Ambulatory Surgical Clinic/Center in Omaha, NE
• Providers in Omaha, NE by specialty
• Ambulatory Surgical Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.