Active NPI
Linda Wasserman, MD
- Pediatrics Physician
- Lakeport, CA
National Provider Identifier
1851371181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME53727
- Practice address
- 5335 Lakeshore Blvd
Lakeport, CA 95453-6123 - Phone
- (707) 263-7725
- Fax
- (707) 263-1096
- NPI assigned
- Jan 20, 2006
- Last updated
- Sep 7, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME53727 | FL | Primary |
Addresses
Primary practice location
5335 Lakeshore Blvd
Lakeport, CA 95453-6123
Mailing address
1306 Century Oak Dr
Ocoee, FL 34761-4026
Phone (407) 247-1832
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048981600 | Medicaid | FL | |
| 201994 | Other | FL | AMERIGROUP |
| 6657345 | Other | FL | CIGNA |
| 102427374756 | Other | FL | HUMANA |
| 199954 | Other | FL | STAYWELL |
| 14845 | Other | FL | BLUE CROSS/BLUE SHIELD |
| 2834021 | Other | FL | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 144654 | CA | MD | Marriage & Family Therapist |
| ME53727 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1851371181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 CENTURY OAK DR",
"city": "OCOEE",
"state": "FL",
"postal_code": "347614026",
"telephone_number": "407-247-1832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5335 LAKESHORE BLVD",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954536123",
"telephone_number": "707-263-7725",
"fax_number": "707-263-1096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSERMAN",
"first_name": "LINDA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME53727",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "048981600",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "201994",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6657345",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "102427374756",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STAYWELL",
"identifier": "199954",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "14845",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2834021",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeport, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.