Jeffrey P. Lake, M.D., Inc.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

A73315 Issued in CA

Legal business name

JEFFREY P. LAKE, M.D., INC.

Practice address

16311 Ventura Blvd
Suite 505
Encino, CA 91436-2124

Phone

(818) 387-8725

NPI assigned

Sep 20, 2010

Organization subpart

No

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

Authorized official

Name

Jeffrey Lake, M.D.NPI 1326006024

Title

Physician/Owner

Phone

(818) 387-8725

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Preston Lake, M.D.

  • Colon & Rectal Surgery Physician
  • Encino, CA
  • NPI 1326006024
  Medicare reassignment Care Compare group NPD Authorized official
• Charles N Headrick, MD

  • Colon & Rectal Surgery Physician
  • Tarzana, CA
  • NPI 1265537831
  Medicare reassignment Care Compare group NPD
• Vemuru Sunil Kumar Reddy, MD

  • Colon & Rectal Surgery Physician
  • Encino, CA
  • NPI 1639451578
  Medicare reassignment Care Compare group NPD
• Daniel Seth Gingold, MD

  • Colon & Rectal Surgery Physician
  • New York, NY
  • NPI 1376834309

  CA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1639487002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16311 VENTURA BLVD",
            "address_2": "SUITE 505",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362124",
            "telephone_number": "818-387-8725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16311 VENTURA BLVD",
            "address_2": "SUITE 505",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362124",
            "telephone_number": "818-387-8725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY P. LAKE, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "818-387-8725",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "A73315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PPIN",
            "identifier": "WA73315A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie Brooks Jefferson, MFT
• Troi Jefferson
• Jeffrey B Glaser MD Medical
• Jeffrey B. Glaser, M.D., Medical Corporation
• Jeffrey D Goss DPM Inc.
• Jeffrey Steinberg MD, Incorporated
• Jeffrey W. Birns, M.D. a Medical Corporation
• Anna Jeffries
• Shameca Jenkins
• William Anthony Jenkins, M.A. BCBA

• Colon & Rectal Surgery Physician in Encino, CA
• Providers in Encino, CA by specialty
• Colon & Rectal Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; 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.