NPIMap

Organization Active NPI

Lakeside Medical Associates, a Medical Group, Inc.

Doing business as Lakeside Community Healthcare Medical Group

  • Family Medicine Physician
  • North Hollywood, CA
National Provider Identifier
1619975158
Registry record updated May 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Doing business as
Lakeside Community Healthcare Medical Group
Practice address
12660 Riverside Dr
Suite 310/320
North Hollywood, CA 91607-3429
Phone
(818) 755-0391
Fax
(818) 753-8165
NPI assigned
Jul 8, 2005
Last updated
May 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2009

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

Authorized official

Name
Kerry E. Weiner, M.D.NPI 1528062437
Title
President
Phone
(818) 637-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CA Primary
Internal Medicine Physician 207R00000X CA
Pediatrics Physician 208000000X CA
Nurse Practitioner 363L00000X CA

Addresses

Primary practice location

12660 Riverside Dr
Suite 310/320
North Hollywood, CA 91607-3429

Mailing address

777 Flower St
Suite a
Glendale, CA 91201-3015
Phone (818) 637-2000

Other identifiers 1

IdentifierTypeStateIssuer
GR0068380MedicaidCA

Other names 1

  • Lakeside Community Healthcare Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Community Healthcare Medical Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

191 S Buena Vista St
Ste 150
Burbank, CA 91505
Phone (818) 295-5920

191 S Buena Vista St
Ste 215
Burbank, CA 91505
Phone (818) 247-4894

191 S Buena Vista St
Ste 230
Burbank, CA 91505

191 S Buena Vista St
Ste 235
Burbank, CA 91505
Phone (818) 524-2003

2211 W Magnolia Blvd
Ste 270
Burbank, CA 91506
Phone (800) 276-2021

2601 W Alameda Ave
Ste 111
Burbank, CA 91505
Phone (818) 847-3960

607 S Glenoaks Blvd
Ste Peds
Burbank, CA 91502

1510 S Central Ave
Ste 200B
Glendale, CA 91204

14901 Rinaldi St
Ste 200
Mission Hills, CA 91345
Phone (818) 254-1500

12660 Riverside Dr
Ste 310320
North Hollywood, CA 91607
Phone (818) 755-0391

24355 Lyons Ave
Ste 200
Santa Clarita, CA 91321
Phone (661) 799-9989

1500 W West Covina Pkwy
Ste 202
West Covina, CA 91790

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1619975158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST",
            "address_2": "SUITE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013015",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12660 RIVERSIDE DR",
            "address_2": "SUITE 310/320",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073429",
            "telephone_number": "818-755-0391",
            "fax_number": "818-753-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-637-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Community Healthcare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; 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.