NPIMap

Organization Active NPI

Lakeside Urgent Care, P.C.

  • Internal Medicine Physician
  • Clinton Township, MI
National Provider Identifier
1811226442
Registry record updated Dec 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAKESIDE URGENT CARE, P.C.
Practice address
44472 Hayes Rd
Clinton Township, MI 48038-1090
Phone
(586) 412-0890
Fax
(586) 412-1069
NPI assigned
Dec 10, 2009
Last updated
Dec 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2009

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

Authorized official

Name
Mrs. Tabatha Leanne Stage
Title
Billing Manager
Phone
(248) 853-2009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MI Primary

Addresses

Primary practice location

44472 Hayes Rd
Clinton Township, MI 48038-1090

Mailing address

44472 Hayes Rd
Clinton Township, MI 48038-1090
Phone (586) 412-0890

Other identifiers 2

IdentifierTypeStateIssuer
1720159304MedicaidMI
700E001600OtherMIBLUE CARE NETWORK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000404 MI Part B Supplier - Clinic/Group Practice 0446146385 Receives reassigned benefits from 137 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton Township, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 137

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.

View all 137

NPI Registry JSON

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1811226442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44472 HAYES RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381090",
            "telephone_number": "586-412-0890",
            "fax_number": "586-412-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44472 HAYES RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381090",
            "telephone_number": "586-412-0890",
            "fax_number": "586-412-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE URGENT CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "STAGE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_middle_name": "LEANNE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "248-853-2009",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720159304",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "700E001600",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.