Active NPI
Kathleen A Lake, M.D.
- Pediatrics Physician
- Springfield, IL
National Provider Identifier
1558343103
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Jun 18, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036-086125
- Practice address
- 301 N 8TH St
Springfield, IL 62701-1041 - Phone
- (217) 545-4238
- Fax
- (217) 545-2303
- NPI assigned
- Nov 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036-086125 | IL | Primary |
Addresses
Primary practice location
301 N 8TH St
Springfield, IL 62701-1041
Mailing address
PO Box 19658
Springfield, IL 62794-9658
Phone (217) 545-4238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-086125 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-086125 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251676800000",
"number": "1558343103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19658",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949658",
"telephone_number": "217-545-4238",
"fax_number": "217-545-2303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N 8TH ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627011041",
"telephone_number": "217-545-4238",
"fax_number": "217-545-2303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "KATHLEEN",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-18",
"last_updated": "2009-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036-086125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-086125",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.