Lake Medical Center, Inc.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

G26382 Issued in CA

Legal business name

LAKE MEDICAL CENTER, INC.

Practice address

1146 San Marino Dr
San Marcos, CA 92078-4649

Phone

(760) 471-2033

Fax

(760) 471-2083

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Michael Shack, M.D.

Title

President

Phone

(760) 471-2033

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 5

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

• Lance Fields Jeppesen, DC

  • Chiropractor
  • San Marcos, CA
  • NPI 1750439451
  Medicare reassignment Care Compare group NPD
• Dale Michael Mauser, DC

  • Chiropractor
  • San Marcos, CA
  • NPI 1366505497
  Medicare reassignment Care Compare group NPD
• Jill Ellen Anna Mauser, DC

  • Chiropractor
  • San Marcos, CA
  • NPI 1033274311
  Medicare reassignment Care Compare group NPD
• Ronald K Shimmin, M.D.

  • General Practice Physician
  • San Marcos, CA
  • NPI 1225153315
  Medicare reassignment NPD
• Aziz N Ander, M.D.

  • Neurology Physician
  • Oceanside, CA
  • NPI 1316131832
  Medicare reassignment

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1689863714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1146 SAN MARINO DR",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920784649",
            "telephone_number": "760-471-2033",
            "fax_number": "760-471-2083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 SAN MARINO DR",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920784649",
            "telephone_number": "760-471-2033",
            "fax_number": "760-471-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "SHACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-471-2033",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC17617",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G26382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kuokoa DME Professional Corporation
• Evan Anothony Kusmier
• Evelyn Kwan, PHARM.D.
• L'Abri Medical
• Natasha Lafave, RN, IHP
• Dominique Hong Lam, OD
• Hanna Lam
• Hong Thu Lam
• Kimberly Tran Lam, PHARMD
• Jeffrey G. Lamb, AMFT 117522

• Neurology Physician in San Marcos, CA
• Providers in San Marcos, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.