Lake Street Family Physicians SC Inc

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

Last updated

Feb 12, 2013By 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

Nancy Bell

Title

Practice Manager

Phone

(708) 524-8600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

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

Practitioners 13

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.

• Matthew Hagenswiecicki, DO

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1730747924
  Medicare reassignment Care Compare group NPD
• Christa Harlin-Egan, MD

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1881171122
  Medicare reassignment Care Compare group NPD
• Paul Anthony Kungl, MD

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1831234749
  Medicare reassignment Care Compare group NPD
• Katherine Louise Maietta, M.D.

  • Internal Medicine Physician
  • Oak Park, IL
  • NPI 1275799710
  Medicare reassignment Care Compare group NPD
• Deborah C Manus, M.D.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1700921699
  Medicare reassignment Care Compare group NPD
• Stephen Whitfield, MD

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1942691613
  Medicare reassignment Care Compare group NPD
• Candice Oberlies, PA-C

  • Physician Assistant
  • Oak Park, IL
  • NPI 1598026536
  Medicare reassignment Care Compare group
• Elizabeth A Werner, PA-C

  • Physician Assistant
  • Oak Park, IL
  • NPI 1518690247
  Medicare reassignment Care Compare group
• Eunice Chan, D.O.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1770847766
  Medicare reassignment NPD
• Allison Donovan, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1003374141
  Medicare reassignment NPD
• Marian Rose Sassetti, M.D.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1881739753
  Medicare reassignment NPD
• Kathryn Vanbuskirk, D.O.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1073045266
  Medicare reassignment NPD

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": [],
    "endpoints": [],
    "other_names": []
}

• Susan Jill Kupperman
• Nicole Kurian, FNP
• Michael L Kyle, MD
• Sydney Lady
• Michelle Lagos, LCSW
• Lakeshore Gastroenterology and Liver Disease Institute S.C.
• Lakeview Speech and Language Clinic, LLC
• Saradkumar M Lakhani, DDS
• Karole A Lakota Treese, MD
• Anand Lal, MD

• Family Medicine Physician in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Family Medicine Physician in Illinois

• 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.