Lakeside Heart and Vascular Center PLLC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

44211 Issued in AZ

Legal business name

LAKESIDE HEART AND VASCULAR CENTER PLLC

Practice address

1741 Mesquite Ave
Suite A100
Lake Havasu City, AZ 86403-5695

Phone

(928) 453-2727

Fax

(928) 453-2828

NPI assigned

Mar 8, 2011

Last updated

Jul 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fadi Atassi, M.D.NPI 1851553119

Title

Owner/Member

Phone

(928) 453-2727

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3291/brand/1/csg/1/fhir/r4

Practitioners 44

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.

• Fadi Atassi, MD

  • Interventional Cardiology Physician
  • Lake Havasu City, AZ
  • NPI 1851553119
  Medicare reassignment Care Compare group Authorized official
• Kalkidan Abebe, MD

  • Internal Medicine Physician
  • Tucson, AZ
  • NPI 1508435504
  Medicare reassignment Care Compare group NPD
• Alexandre Miguel Benjo, MD

  • Interventional Cardiology Physician
  • Tucson, AZ
  • NPI 1164606448

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Jenniffer Blair, FNP-C

  • Family Nurse Practitioner
  • Lake Havasu City, AZ
  • NPI 1265804124
  Medicare reassignment Care Compare group NPD
• Rafael Francisco Chupeco Go, MD, MBA, MS

  • Interventional Cardiology Physician
  • Lake Havasu City, AZ
  • NPI 1699296319
  Medicare reassignment Care Compare group NPD
• Michael Ramsey Jerman, MD

  • Cardiovascular Disease Physician
  • Safford, AZ
  • NPI 1588667596
  Medicare reassignment Care Compare group NPD
• George P Jolly, M.D.

  • Cardiovascular Disease Physician
  • Lake Havasu City, AZ
  • NPI 1427504299
  Medicare reassignment Care Compare group NPD
• Alie Riad Jreisat, MD

  • Family Medicine Physician
  • Kingman, AZ
  • NPI 1578130555
  Medicare reassignment Care Compare group NPD
• James Kneller, MD

  • Clinical Cardiac Electrophysiology Physician
  • Phoenix, AZ
  • NPI 1861641581

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Brittney Mahnke, ACNP-AG

  • Gerontology Nurse Practitioner
  • Lake Havasu City, AZ
  • NPI 1265091276
  Medicare reassignment Care Compare group NPD
• Paul Andrew Mahnke, ACNPC-AG

  • Nurse Practitioner
  • Lake Havasu City, AZ
  • NPI 1982123618
  Medicare reassignment Care Compare group NPD
• Traci Moore, APRN, FNP-C

  • Family Nurse Practitioner
  • Kingman, AZ
  • NPI 1225570005
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1801194352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3539",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864053539",
            "telephone_number": "928-453-2727",
            "fax_number": "928-453-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 MESQUITE AVE",
            "address_2": "SUITE A100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035695",
            "telephone_number": "928-453-2727",
            "fax_number": "928-453-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HEART AND VASCULAR CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-08",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "ATASSI",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "928-453-2727",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "44211",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "44211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Havasu Too, LLC (Prestige Assisted Living at Claremont)
• Lake Havasu Unified School Distrct
• Lake Havasu Unified School District #1
• Lake View Terrace Management LLC
• Lake View Terrace Memory Care (LHC Partners LP)
• Lakeside Neurology LLC
• Lakeside Orthopedic Institute LLC
• Lakeside Orthopedic Institute LLC (Lakeside CT)
• Lakeside Orthopedic Institute LLC (Lakeside Mobile Imaging)
• Lakeside Orthopedic Institute LLC

• Interventional Cardiology Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Interventional Cardiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; 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.