NPIMap

Organization Active NPI

Lake Country Pediatrics SC

Doing business as Lake Country Physicians

  • Pediatrics Physician
  • Oconomowoc, WI
National Provider Identifier
1801849963
Registry record updated Aug 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35710 Issued in WI
Legal business name
LAKE COUNTRY PEDIATRICS SC
Doing business as
Lake Country Physicians
Practice address
970 S Silver Lake St
Ste. 102
Oconomowoc, WI 53066-3802
Phone
(262) 569-7100
Fax
(262) 567-6295
NPI assigned
May 18, 2006
Last updated
Aug 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2011

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

Authorized official

Name
Dr. Gregory M Moyer, M.D.NPI 1619940947
Title
Dr.
Phone
(262) 569-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 35710 WI Primary

Addresses

Primary practice location

970 S Silver Lake St
Ste. 102
Oconomowoc, WI 53066-3802

Mailing address

970 S Silver Lake St
Ste. 102
Oconomowoc, WI 53066-3802
Phone (262) 569-7100

Other identifiers 1

IdentifierTypeStateIssuer
21250600MedicaidWI

Other names 1

  • Lake Country Physicians Doing business as

National Provider Directory

National Provider Directory

Locations

970 S Silver Lake St
Ste 102
Oconomowoc, WI 53066
Phone (262) 569-7100

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1801849963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 S SILVER LAKE ST",
            "address_2": "STE. 102",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663802",
            "telephone_number": "262-569-7100",
            "fax_number": "262-567-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 S SILVER LAKE ST",
            "address_2": "STE. 102",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663802",
            "telephone_number": "262-569-7100",
            "fax_number": "262-567-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "MOYER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DR.",
        "authorized_official_telephone_number": "262-569-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "35710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21250600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Country Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.