NPIMap

Organization Active NPI

Clinical Practice of Lecom Institute for Successful Living

Doing business as LECOM Institute for Successful Living

  • Internal Medicine Physician
  • Erie, PA
National Provider Identifier
1912768425
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Doing business as
LECOM Institute for Successful Living
Practice address
5401 Peach St Ste 3400
Erie, PA 16509-2601
Phone
(814) 868-2200
NPI assigned
Jan 22, 2024
Last updated
Jan 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLCREEK MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Authorized official

Name
James Y Lin, DONPI 1164599155
Title
President
Phone
(814) 602-7783

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
Durable Medical Equipment & Medical Supplies 332B00000X
Internal Medicine Physician 207R00000X Primary
Cardiovascular Disease Physician 207RC0000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X
Vascular Surgery Physician 2086S0129X
Podiatrist 213E00000X

Addresses

Primary practice location

5401 Peach St Ste 3400
Erie, PA 16509-2601

Mailing address

5401 Peach St Ste 3400
Erie, PA 16509-2601
Phone (814) 868-2200

Other practice location 1

16954 Conneaut Lake Rd
Meadville, PA 16335-3738
Phone (814) 844-2858

Other names 1

  • LECOM Institute for Successful Living Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240402000412 PA Part B Supplier - Clinic/Group Practice 2466890033 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
Practice locations: Erie, PA; Meadville, PA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Millcreek Manor

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9040 Wattsburg Rd
Erie, PA 16509
Phone (814) 737-0833

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1912768425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST STE 3400",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601",
            "telephone_number": "814-868-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST STE 3400",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601",
            "telephone_number": "814-868-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16954 Conneaut Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Meadville",
            "state": "PA",
            "postal_code": "163353738",
            "country_code": "US",
            "telephone_number": "814-844-2858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK MANOR",
        "enumeration_date": "2024-01-22",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "LIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-602-7783",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Institute for Successful Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.