NPIMap

Organization Active NPI

Lake Oliver Emergency Group, LLC

  • Emergency Medicine Physician
  • Quincy, FL
National Provider Identifier
1639830128
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LAKE OLIVER EMERGENCY GROUP, LLC
Practice address
23186 Blue Star Hwy
Quincy, FL 32351-5173
Phone
(850) 875-6000
NPI assigned
Jan 6, 2022
Last updated
Sep 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Emergency Medicine Physician 207P00000X NU Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X NU

Addresses

Primary practice location

23186 Blue Star Hwy
Quincy, FL 32351-5173

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (337) 609-1153

Other names 1

  • Capital Regional Medical Center Gadsden ER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220413002299 FL Part B Supplier - Clinic/Group Practice 4688060940 Receives reassigned benefits from 105 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallahassee, FL; Quincy, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639830128. Details of each certification follow.

Hospital certification: CCN 100159

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CAPITAL REGIONAL MEDICAL CENTER,GADSDEN
Certification status
Terminated Other: provider status change, Jun 4, 2001
Provider type (POS)
Hospital – Short-term
Participating since
Jul 22, 1966
Last certification
Mar 27, 2001
Beds
51
Ownership / control type
Other
Facility address
23186 Blue Star Hwy
Quincy, FL 32351

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1639830128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "337-609-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23186 BLUE STAR HWY",
            "city": "QUINCY",
            "state": "FL",
            "postal_code": "323515173",
            "telephone_number": "850-875-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OLIVER EMERGENCY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Regional Medical Center Gadsden ER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Capital Regional Medical Center Gadsden ER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Quincy, FL

Sources for this page

Verify at the official NPI Registry.