NPIMap

Organization Active NPI

Lake Region Medical Center, P.C.

  • Family Medicine Physician
  • Berrien Springs, MI
National Provider Identifier
1912105602
Registry record updated Apr 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKE REGION MEDICAL CENTER, P.C.
Practice address
8981 George Ave
Berrien Springs, MI 49103-1407
Phone
(269) 471-9436
NPI assigned
Jul 5, 2007
Last updated
Apr 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2011

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

Authorized official

Name
Dr. Charles Andrew Mosimbwa, M.D.NPI 1215134408
Title
Medical Director
Phone
(269) 362-7791

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Pediatrics Physician 208000000X NU
Body Imaging Physician 2085B0100X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

8981 George Ave
Berrien Springs, MI 49103-1407

Mailing address

8981 George Ave
Berrien Springs, MI 49103-1407
Phone (269) 471-9436

Other names 1

  • GOODHOPE MEDICAL GROUP Other name

National Provider Directory

National Provider Directory
Tax ID family
Goodhope Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301616000000",
    "number": "1912105602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8981 GEORGE AVE",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031407",
            "telephone_number": "269-471-9436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8981 GEORGE AVE",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031407",
            "telephone_number": "269-471-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGION MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2011-04-01",
        "status": "A",
        "authorized_official_last_name": "MOSIMBWA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "269-362-7791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOODHOPE MEDICAL GROUP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berrien Springs, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2011; 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.