NPIMap

Organization Active NPI

Lakeside Memorial Hospital Inc.

  • General Acute Care Hospital
  • Brockport, NY
National Provider Identifier
1639136153
Registry record updated Aug 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
LAKESIDE MEMORIAL HOSPITAL INC.
Practice address
156 West Ave
Brockport, NY 14420-1229
Phone
(585) 395-6095
Fax
(585) 395-6036
NPI assigned
Apr 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2009

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

Authorized official

Name
Michael Stapleton
Title
Ceo
Phone
(585) 395-6095

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Urgent Care Clinic/Center 261QU0200X NY
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

156 West Ave
Brockport, NY 14420-1229

Mailing address

156 West Ave
Brockport, NY 14420-1229
Phone (585) 395-6095

Other identifiers 8

IdentifierTypeStateIssuer
14005907OtherNYEXCELLUS - OUTPATIENT
100003CFOtherNYPREFERRED CARE
106418AZOtherNYPREFERRED CARE-PHYS & MID
70000AOtherNYMEDICARE-PHYS & MID PRACT
02198570OtherNYMEDICAID-PHYS & MID PRACT
14005907OtherNYEXCELLUS-PHYS & MID PRACT
00279543MedicaidNY
12005907OtherNYEXCELLUS - INPATIENT

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251158400000",
    "number": "1639136153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2009-08-25",
        "status": "A",
        "authorized_official_last_name": "STAPLETON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "585-395-6095"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS - OUTPATIENT",
            "identifier": "14005907",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "100003CF",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE-PHYS & MID",
            "identifier": "106418AZ",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-PHYS & MID PRACT",
            "identifier": "70000A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-PHYS & MID PRACT",
            "identifier": "02198570",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS-PHYS & MID PRACT",
            "identifier": "14005907",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00279543",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS - INPATIENT",
            "identifier": "12005907",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.