NPIMap

Organization Active NPI

La Lakers

  • Primary Care Clinic/Center
  • Gainesville, FL
National Provider Identifier
1578228375
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LA LAKERS
Practice address
2101 NE 2ND St Apt 114
Gainesville, FL 32609-8626
Phone
(352) 792-8069
NPI assigned
Nov 5, 2021
Last updated
Nov 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Authorized official

Name
Raven Mayes, DO ONA CNA APN
Title
Osteopathic Medicine Physician
Phone
(352) 792-8069

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Nursing Care Agency 251J00000X NU
Ambulatory Family Planning Facility 261QA0005X NU
Emergency Care Clinic/Center 261QE0002X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Pharmacy 333600000X NU
Respite Care 385H00000X NU
Department of Veterans Affairs (VA) Pharmacy 332100000X NU
Meals Provider 174200000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

2101 NE 2ND St Apt 114
Gainesville, FL 32609-8626

Mailing address

PO Box 5393
Gainesville, FL 32627-5393
Phone (352) 792-8069

Other names 1

  • Attn: Jamie Bus Adam Silver Other name

National Provider Directory

National Provider Directory
Tax ID family
Acute Care6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636070400000",
    "number": "1578228375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5393",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326275393",
            "telephone_number": "352-792-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NE 2ND ST APT 114",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326098626",
            "telephone_number": "352-792-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA LAKERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-05",
        "last_updated": "2021-11-05",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "MAYES",
        "authorized_official_first_name": "RAVEN",
        "authorized_official_title_or_position": "OSTEOPATHIC MEDICINE PHYSICIAN",
        "authorized_official_telephone_number": "352-792-8069",
        "authorized_official_credential": "DO ONA CNA APN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332100000X",
            "taxonomy_group": "",
            "desc": "Department of Veterans Affairs (VA) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Attn: Jamie Bus Adam Silver",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.