NPIMap

Organization Active NPI

Lakeside Medical Associates, a Medical Group, Inc.

  • Family Medicine Physician
  • Santa Clarita, CA
National Provider Identifier
1659317634
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.
Practice address
24355 Lyons Ave
Suite 210
Santa Clarita, CA 91321-2300
Phone
(661) 222-9381
Fax
(661) 222-2264
NPI assigned
Jun 20, 2006
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.
Title
President
Phone
(818) 637-2000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X CA

Addresses

Primary practice location

24355 Lyons Ave
Suite 210
Santa Clarita, CA 91321-2300

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GR0068381MedicaidCA

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1659317634",
    "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": "24355 LYONS AVE",
            "address_2": "SUITE 210",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913212300",
            "telephone_number": "661-222-9381",
            "fax_number": "661-222-2264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "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": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068381",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Community Healthcare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Clarita, 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.