NPIMap

Organization Active NPI

Lake Street Family Physicians SC Inc

  • Family Medicine Physician
  • Oak Park, IL
National Provider Identifier
1841363850
Registry record updated Feb 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042618366 Issued in IL
Legal business name
LAKE STREET FAMILY PHYSICIANS SC INC
Practice address
1010 W Lake St
Suite 500
Oak Park, IL 60301
Phone
(708) 524-8600
Fax
(708) 524-8147
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2013

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

Authorized official

Name
Nancy Bell
Title
Practice Manager
Phone
(708) 524-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 042618366 IL Primary

Addresses

Primary practice location

1010 W Lake St
Suite 500
Oak Park, IL 60301

Mailing address

PO Box 799
Oak Park, IL 60303
Phone (708) 524-8600

Other identifiers 2

IdentifierTypeStateIssuer
DD3406OtherILMEDICARE RAILROAD
01634822OtherILBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041110000631 IL Part B Supplier - Clinic/Group Practice 8123081189 Receives reassigned benefits from 13 practitioners
Practice locations: Oak Park, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0981005Lake Street Family Physicians1010 Lake Street-Suite 301, Oak Park, IL 60301Provider-performed microscopyFeb 1, 2028

National Provider Directory

National Provider Directory

Locations

1011 Lake St
Fl First
Oak Park, IL 60301
Phone (708) 524-8600

1010 Lake St
Ste 500
Oak Park, IL 60301
Phone (708) 524-8600

1010 Lake St
Ste 301
Oak Park, IL 60301
Phone (708) 524-8600

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFAFDD

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1841363850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 799",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60303",
            "telephone_number": "708-524-8600",
            "fax_number": "708-524-8147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W LAKE ST",
            "address_2": "SUITE 500",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60301",
            "telephone_number": "708-524-8600",
            "fax_number": "708-524-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STREET FAMILY PHYSICIANS SC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "708-524-8600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042618366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DD3406",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01634822",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.