NPIMap

Organization Active NPI

Lakeside Medical Associates, a Medical Group, Inc.

Doing business as Lakeside Community Healthcare Medical Group

  • Rheumatology Physician
  • Burbank, CA
National Provider Identifier
1861499535
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
Doing business as
Lakeside Community Healthcare Medical Group
Practice address
191 S Buena Vista St
Suite 420
Burbank, CA 91505-4554
Phone
(818) 557-7399
Fax
(818) 848-1543
NPI assigned
Jul 7, 2005
Last updated
Mar 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

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

Authorized official

Name
Kerry E. Weiner, M.D.NPI 1528062437
Title
President
Phone
(818) 637-2000

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CA
Pulmonary Disease Physician 207RP1001X NU
Rheumatology Physician 207RR0500X NU Primary
Surgery Physician 208600000X NU

Addresses

Primary practice location

191 S Buena Vista St
Suite 420
Burbank, CA 91505-4554

Mailing address

777 Flower St
Suite a
Glendale, CA 91201-3015
Phone (818) 637-2000

Other identifiers 1

IdentifierTypeStateIssuer
GR0068386MedicaidCA

Other names 1

  • Lakeside Community Healthcare Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Community Healthcare Medical Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Practitioners & affiliated clinicians

Practitioners 128

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 128

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1861499535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST",
            "address_2": "SUITE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013015",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 S BUENA VISTA ST",
            "address_2": "SUITE 420",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054554",
            "telephone_number": "818-557-7399",
            "fax_number": "818-848-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-637-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068386",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Community Healthcare Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.