Lake Shore OB GYN of Decatur S C

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAKE SHORE OB GYN OF DECATUR S C

Practice address

741 W Pershing Rd
Decatur, IL 62526-1634

Phone

(217) 429-4119

Fax

(217) 429-0108

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Adel Samy Hanna, M.D.

Title

Owner

Phone

(217) 429-4119

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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

• Nada Lygrisse, D.O

  • Obstetrics & Gynecology Physician
  • Decatur, IL
  • NPI 1871919134
  Medicare reassignment Care Compare group NPD
• Adel Samy Raheb, M.D.

  • Obstetrics & Gynecology Physician
  • Champaign, IL
  • NPI 1265418982
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1700925583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 E LAKE SHORE DR",
            "address_2": "SUITE 303",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213832",
            "telephone_number": "217-429-4119",
            "fax_number": "217-429-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 W PERSHING RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625261634",
            "telephone_number": "217-429-4119",
            "fax_number": "217-429-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE OB GYN OF DECATUR S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "ADEL",
        "authorized_official_middle_name": "SAMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-429-4119",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "634112",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05832038",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110172",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Don Michael Kyle Sr., P.T.
• Steven J Lafleur
• Kristin Lafollette, RPH
• Lake of Decatur Inc
• Lake of Decatur Inc
• Hannah Lamb, LPC
• Karen Lamb, P.T.
• Katy J Lambert, LCSW
• Richard Paul Landgrebe, CRNA
• Sabrina Lane, COTA/L

• Specialist in Decatur, IL
• Providers in Decatur, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; 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.