NPIMap

Organization Active NPI

Lakeside Orthopedic Institute, LLC

  • Orthopaedic Surgery Physician
  • Quartzsite, AZ
National Provider Identifier
1902137417
Registry record updated Feb 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
13802 Issued in AZ
Legal business name
LAKESIDE ORTHOPEDIC INSTITUTE, LLC
Practice address
150 East Tyson Rd
Quartzsite, AZ 85359
Phone
(928) 505-5555
Fax
(928) 505-2877
NPI assigned
Jan 22, 2010
Last updated
Feb 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2011

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

Authorized official

Name
William F Binder, M.D.NPI 1043245293
Title
Partner
Phone
(928) 505-5555

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 23186 AZ
Orthopaedic Surgery Physician 207X00000X 34564 AZ
Orthopaedic Surgery Physician 207X00000X 26379 AZ
Orthopaedic Surgery Physician 207X00000X 13802 AZ Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 0554 AZ

Addresses

Primary practice location

150 East Tyson Rd
Quartzsite, AZ 85359

Mailing address

25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone (928) 505-5555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060918000307 AZ Part B Supplier - Clinic/Group Practice 1052316445 Receives reassigned benefits from 14 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quartzite, AZ; Lake Havasu City, AZ; Bullhead City, AZ

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

25 Riviera Dr
AZ 86403

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297900800000",
    "number": "1902137417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 RIVIERA BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035694",
            "telephone_number": "928-505-5555",
            "fax_number": "928-505-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 EAST TYSON RD",
            "city": "QUARTZSITE",
            "state": "AZ",
            "postal_code": "85359",
            "telephone_number": "928-505-5555",
            "fax_number": "928-505-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ORTHOPEDIC INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2011-02-17",
        "status": "A",
        "authorized_official_last_name": "BINDER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "928-505-5555",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "23186",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "34564",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "26379",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "13802",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0554",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quartzsite, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; 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.