NPIMap

Organization Active NPI

Lake Hospital System, Inc.

  • Vascular Surgery Physician
  • Warrensville Heights, OH
National Provider Identifier
1669609756
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
LAKE HOSPITAL SYSTEM, INC.
Practice address
20050 Harvard Ave
Warrensville Heights, OH 44122-6816
Phone
(440) 953-1898
Fax
(440) 953-9296
NPI assigned
Jun 16, 2009
Reactivated
Dec 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

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

Authorized official

Name
Laurie Hogya
Title
Credentialng Assistant
Phone
(440) 354-1899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

20050 Harvard Ave
Warrensville Heights, OH 44122-6816

Mailing address

PO Box 714328
Columbus, OH 43271-4328
Phone (440) 354-1899

Other names 1

  • Lake Health Physician Group Vascular Access Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000963 OH Part B Supplier - Clinic/Group Practice 6002713922 Receives reassigned benefits from 333 practitioners
40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 39

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

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Lake Medical Center37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 8

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": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1669609756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 714328",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432714328",
            "telephone_number": "440-354-1899",
            "fax_number": "440-354-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20050 HARVARD AVE",
            "city": "WARRENSVILLE HEIGHTS",
            "state": "OH",
            "postal_code": "441226816",
            "telephone_number": "440-953-1898",
            "fax_number": "440-953-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2011-12-29",
        "deactivation_date": "2011-06-08",
        "reactivation_date": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "HOGYA",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "CREDENTIALNG ASSISTANT",
        "authorized_official_telephone_number": "440-354-1899"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Health Physician Group Vascular Access Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrensville Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.