Lake Internal Medicine Associates

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

LAKE INTERNAL MEDICINE ASSOCIATES

Practice address

2101 Prevatt St
Eustis, FL 32726-6131

Phone

(352) 589-4774

Fax

(352) 589-5092

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Bonnie L Demuth

Title

Practice Manager

Phone

(352) 589-4774

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

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

• Robin Nielsen, APRN

  • Family Nurse Practitioner
  • Eustis, FL
  • NPI 1750069209
  Medicare reassignment Care Compare group NPD
• Elizabeth Shirley

  • Family Nurse Practitioner
  • Eustis, FL
  • NPI 1659904761
  Medicare reassignment Care Compare group NPD
• Tina D. Walker, ARNP

  • Family Nurse Practitioner
  • Eustis, FL
  • NPI 1588308860
  Medicare reassignment Care Compare group NPD
• Angela Dawn Bethune, ARNP

  • Family Nurse Practitioner
  • Flat Rock, AL
  • NPI 1942258272
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1679595649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 PREVATT ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266131",
            "telephone_number": "352-589-4774",
            "fax_number": "352-589-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 PREVATT ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266131",
            "telephone_number": "352-589-4774",
            "fax_number": "352-589-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE INTERNAL MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "DEMUTH",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "352-589-4774"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Primary Medical Care LLC
• Lake County Spine and Injury
• Lake Eustis Operating Investments LLC
• Lake Foot Clinic Inc
• Lake Health Care Center Inc
• Lake Respiratory Services, Inc.
• Lake View Nutrition Consulting SVCS. Inc.
• Lake Women for Women OB/GYN,LLC
• Lamb Audiology LLC
• Kimberly Sue Lamb, AU.D.

• Family Nurse Practitioner in Eustis, FL
• Providers in Eustis, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.