NPIMap

Organization Active NPI

Lake Hospital System, Inc

Doing business as Lake Health Urgent Care and Walk In Clinic

  • Urgent Care Clinic/Center
  • Chardon, OH
National Provider Identifier
1689634966
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
LAKE HOSPITAL SYSTEM, INC
Doing business as
Lake Health Urgent Care and Walk In Clinic
Practice address
510 5TH Ave
Chardon, OH 44024-1077
Phone
(440) 286-8908
Fax
(440) 257-1527
NPI assigned
Mar 23, 2006
Last updated
Feb 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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

Authorized official

Name
Mr. Robert Tracz
Title
Cfo
Phone
(440) 354-1952

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
General Practice Physician 208D00000X NU
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

510 5TH Ave
Chardon, OH 44024-1077

Mailing address

PO Box 781348
Detroit, MI 48278-4110
Phone (440) 286-8908

Other identifiers 6

IdentifierTypeStateIssuer
80507OtherOHQUALCHOICE
264200003OtherOHFEDERAL BLACK LUNG
2017301MedicaidOH
2475352MedicaidOH
264200003OtherOHDEPT OF LABOR
6600162OtherOHUNITED HEALTHCARE

Other names 1

  • Lake Health Urgent Care and Walk In Clinic 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

Locations (25 of 42)

355 W Prospect Rd
Ste 123
Ashtabula, OH 44004
Phone (440) 998-3395

517 W Prospect Rd
Ste C
Ashtabula, OH 44004
Phone (440) 998-3385

16575 S Franklin St
Chagrin Falls, OH 44023
Phone (440) 247-1300

510 5th Ave
Ste 100
Chardon, OH 44024
Phone (440) 279-1590

510 5th Ave
Ste 120
Chardon, OH 44024
Phone (216) 844-3009

510 5th Ave
Ste 130
Chardon, OH 44024
Phone (440) 279-1500

5 Severance Cir
Cleveland Heights, OH 44118
Phone (216) 291-3020

7580 Auburn Rd
Ste 210
Concord Township, OH 44077
Phone (440) 375-8198

7580 Auburn Rd
Ste 211
Concord Township, OH 44077
Phone (440) 354-1626

7590 Auburn Rd
#207
Concord Township, OH 44077
Phone (440) 354-1802

7590 Auburn Rd
Ste 207
Concord Township, OH 44077
Phone (440) 354-1802

25701 N Lakeland Blvd
Ste 305
Euclid, OH 44132
Phone (216) 731-5212

6990 Lindsay Dr
Ste 3
Mentor, OH 44060
Phone (440) 255-7938

8401 Mentor Ave
Mentor, OH 44060
Phone (440) 205-1730

9170 Mentor Ave
Mentor, OH 44060
Phone (440) 352-1200

9485 Mentor Ave
Ste 101
Mentor, OH 44060
Phone (440) 205-5800

9485 Mentor Ave
Ste A4
Mentor, OH 44060
Phone (440) 639-0900

9500 Mentor Ave
Ste 120
Mentor, OH 44060
Phone (440) 255-5506

9500 Mentor Ave
Ste 200
Mentor, OH 44060
Phone (440) 205-5433

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

150 Mentor Ave
#2
Painesville, OH 44077
Phone (216) 354-4312

74 S Park Pl
Painesville, OH 44077
Phone (440) 354-3887

2 Success Blvd
Perry, OH 44081
Phone (440) 375-8590

36001 Euclid Ave
#C7
Willoughby, OH 44094
Phone (440) 602-6710

36001 Euclid Ave
Ste 300
Willoughby, OH 44094
Phone (440) 953-1898

Practitioners & affiliated clinicians

Practitioners 384

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.

View all 384

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487289600000",
    "number": "1689634966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781348",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482784110",
            "telephone_number": "440-286-8908",
            "fax_number": "440-279-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 5TH AVE",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241077",
            "telephone_number": "440-286-8908",
            "fax_number": "440-257-1527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2017-02-17",
        "status": "A",
        "authorized_official_last_name": "TRACZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "440-354-1952",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "80507",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "264200003",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017301",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2475352",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "264200003",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "6600162",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Health Urgent Care and Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chardon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; 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.