NPIMap

Organization Active NPI

Lakeshore Anesthesia, P.C.

  • Anesthesiology Physician
  • Hobart, IN
National Provider Identifier
1548210560
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
LAKESHORE ANESTHESIA, P.C.
Practice address
1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone
(219) 942-0551
NPI assigned
May 11, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Derek Cheuk, MDNPI 1295719797
Title
President/Ceo
Phone
(219) 267-0094

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

1500 S Lake Park Ave
Hobart, IN 46342-6638

Mailing address

PO Box 11581
Fort Wayne, IN 46859-1581
Phone (219) 267-0094

Other practice location 1

50819 Hidden Forest Dr
South Bend, IN 46628
Phone (219) 267-0094

Other identifiers 1

IdentifierTypeStateIssuer
200196230MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051213000682 IN Part B Supplier - Clinic/Group Practice 1951322353 Receives reassigned benefits from 38 practitioners
Practice locations: Valparaiso, IN; Peru, IN; Hobart, IN; La Porte, IN

National Provider Directory

National Provider Directory

Locations

1755 Fulton St
#A
Elkhart, IN 46514
Phone (574) 522-0800

3080 Windsor Ct
#B
Elkhart, IN 46514
Phone (574) 266-7817

Practitioners & affiliated clinicians

Practitioners 58

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.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1548210560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11581",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468591581",
            "telephone_number": "219-267-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426638",
            "telephone_number": "219-942-0551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50819 Hidden Forest Dr",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "46628",
            "country_code": "US",
            "telephone_number": "219-267-0094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESHORE ANESTHESIA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "CHEUK",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "219-267-0094",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200196230",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.