NPIMap

Organization Active NPI

Lakeside Orthopedic Institute LLC

  • Orthopaedic Surgery Physician
  • Lake Havasu City, AZ
National Provider Identifier
1679764229
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
LAKESIDE ORTHOPEDIC INSTITUTE LLC
Practice address
25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone
(928) 505-5555
NPI assigned
Aug 8, 2007
Last updated
Apr 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Authorized official

Name
Daniel Edward Heiner, MDNPI 1841270873
Title
Partner
Phone
(928) 505-5555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary
Interventional Pain Medicine Physician 208VP0014X NU
Physical Therapist 225100000X NU
Magnetic Resonance Imaging Radiologic Technologist 2471M1202X NU

Addresses

Primary practice location

25 Riviera Blvd
Lake Havasu City, AZ 86403-5694

Mailing address

25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone (928) 505-5555

Other identifiers 1

IdentifierTypeStateIssuer
DF0357OtherAZMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, NV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20060918000307 AZ Part B Supplier - Clinic/Group Practice 1052316445 Receives reassigned benefits from 14 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quartzite, AZ; Lake Havasu City, AZ; Bullhead City, AZ
O20100930059486 AZ DME Supplier - Physician - General Practice 1052316445 Practice locations: Lake Havasu City, AZ
O20230906000868 NV Part B Supplier - Clinic/Group Practice 1052316445 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Physical Therapy Rehab Sports Medicine7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3003 Highway 95
Bldg F63
Bullhead City, AZ 86442

25 Riviera Blvd
Lk Havasu Cty, AZ 86403
Phone (928) 505-7246

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776816000000",
    "number": "1679764229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 RIVIERA BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035694",
            "telephone_number": "928-505-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 RIVIERA BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035694",
            "telephone_number": "928-505-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ORTHOPEDIC INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A",
        "authorized_official_last_name": "HEINER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "928-505-5555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DF0357",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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.