NPIMap

Organization Active NPI

Lakeshore Medical Clinic, LLC

  • Durable Medical Equipment & Medical Supplies
  • Muskego, WI
National Provider Identifier
1922356252
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
LAKESHORE MEDICAL CLINIC, LLC
Practice address
S68W15500 Janesville Rd
Muskego, WI 53150-2613
Phone
(414) 764-3241
Fax
(414) 762-4225
NPI assigned
Aug 16, 2012
Last updated
Oct 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
Kara Richardson
Title
Asst Treasurer
Phone
(704) 631-0450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

S68W15500 Janesville Rd
Muskego, WI 53150-2613

Mailing address

100 15TH Ave Ste 180
South Milwaukee, WI 53172-1160
Phone (414) 768-5430

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130926000441 WI DME Supplier - Multi-Specialty - Physician 7719890730 Practice locations: Muskego, WI

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Lakeshore Medical Group7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1922356252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 15TH AVE STE 180",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721160",
            "telephone_number": "414-768-5430",
            "fax_number": "414-762-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S68W15500 JANESVILLE RD",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531502613",
            "telephone_number": "414-764-3241",
            "fax_number": "414-762-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "KARA",
        "authorized_official_title_or_position": "ASST TREASURER",
        "authorized_official_telephone_number": "704-631-0450"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "64 S Price Rd STE B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Muskego, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; 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.