Active NPI
Lake Hospital System, Inc
- Clinic/Center
- Painesville, OH
National Provider Identifier
1699000281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- LAKE HOSPITAL SYSTEM, INC
- Practice address
- 74 S Park Place
Painesville, OH 44077 - Phone
- (440) 354-3887
- Fax
- (440) 354-4071
- NPI assigned
- Oct 15, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Tracz
- Title
- Cfo
- Phone
- (440) 354-1952
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
74 S Park Place
Painesville, OH 44077
Mailing address
PO Box 781348
Detroit, MI 48278-1348
Phone (440) 354-3887
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2017301 | Medicaid | OH |
Other names 1
- Lake Health Walk In Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
Other NPIs on the same Medicare enrollment 39
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
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National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Mentor, OH
- NPI 1124045919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255564800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1487289600000",
"number": "1699000281",
"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": "482781348",
"telephone_number": "440-354-3887",
"fax_number": "440-354-4071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 S PARK PLACE",
"city": "PAINESVILLE",
"state": "OH",
"postal_code": "44077",
"telephone_number": "440-354-3887",
"fax_number": "440-354-4071"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE HOSPITAL SYSTEM, INC",
"organizational_subpart": "NO",
"enumeration_date": "2009-10-15",
"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"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2017301",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lake Health Walk In Center",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Painesville, 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.