NPIMap

Organization Active NPI

Lakeside Family Physicians PLLC

  • Primary Care Clinic/Center
  • Issaquah, WA
National Provider Identifier
1891902458
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LAKESIDE FAMILY PHYSICIANS PLLC
Practice address
390 E Sunset Way
Issaquah, WA 98027-3441
Phone
(425) 246-0225
Fax
(425) 395-0245
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Samantha Maplethorpe, MDNPI 1396768412
Title
Owner
Phone
(425) 369-1342

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X WA Primary

Addresses

Primary practice location

390 E Sunset Way
Issaquah, WA 98027-3441

Mailing address

2623 W Pumpkin Ridge Dr
Anthem, AZ 85086-3027
Phone (425) 369-1342

Other practice location 1

3719 W Anthem Way Ste 200
Anthem, AZ 85086-0469
Phone (425) 369-1342

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060215000098 WA Part B Supplier - Clinic/Group Practice 6002821832 Receives reassigned benefits from 1 practitioner
Practice locations: Issaquah, WA

National Provider Directory

National Provider Directory

Locations

3719 W Anthem Way
Ste 102
Anthem, AZ 85086
Phone (623) 232-0082

3719 W Anthem Way
Ste 200
Anthem, AZ 85086
Phone (425) 369-1342

3707 Providence Dr SE
Ste G
Issaquah, WA 98029
Phone (425) 369-1342

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1293/brand/3/csg/42/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1891902458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 W PUMPKIN RIDGE DR",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850863027",
            "telephone_number": "425-369-1342",
            "fax_number": "623-440-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 E SUNSET WAY",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980273441",
            "telephone_number": "425-246-0225",
            "fax_number": "425-395-0245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3719 W Anthem Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Anthem",
            "state": "AZ",
            "postal_code": "850860469",
            "country_code": "US",
            "telephone_number": "425-369-1342",
            "fax_number": "623-440-0501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE FAMILY PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "MAPLETHORPE",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-369-1342",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.