Vasu Nagaraju Lakkimsetti, M.D.,

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

ME103433 Issued in FL

Practice address

619 S Marion Ave
Routing # 11 Fa
Lake City, FL 32025-5808

Phone

(386) 755-3016

NPI assigned

Jan 9, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288224000000",
    "number": "1679710834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 S MARION AVE",
            "address_2": "ROUTING # 11 FA",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255808",
            "telephone_number": "386-755-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S MARION AVE",
            "address_2": "ROUTING # 11 FA",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255808",
            "telephone_number": "386-755-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKKIMSETTI",
        "first_name": "VASU",
        "middle_name": "NAGARAJU",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-09",
        "last_updated": "2010-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "12871",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME103433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Citytherapeutic LLC
• Lake Shore Center for Aesthetics & Plastic Surgery PA
• Lake Shore Hma Medical Group LLC
• Lake Shore Hma, LLC
• Lake Shore Hma, LLC
• Anthony R Lambert, PA-C
• Paula Lamon, ARNP
• Carol Landen
• Rickey Ellis Landon, M.D.
• Lorielle Manning Lang, APRN

• Geriatric Medicine (Family Medicine) Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Geriatric Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.