NPIMap

Organization Active NPI

Lakeland Medical Practices

Doing business as Lakeside Urology

  • Urology Physician
  • Niles, MI
National Provider Identifier
1932493863
Registry record updated Jul 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301036136 Issued in MI
Legal business name
LAKELAND MEDICAL PRACTICES
Doing business as
Lakeside Urology
Practice address
42 N Saint Joseph Ave
Suite 200
Niles, MI 49120-2208
Phone
(269) 684-5447
Fax
(269) 684-0256
NPI assigned
Jun 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2012

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

Authorized official

Name
Jancie Crocker
Title
Director, Practice Operations
Phone
(268) 687-1152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 4301036136 MI Primary

Addresses

Primary practice location

42 N Saint Joseph Ave
Suite 200
Niles, MI 49120-2208

Mailing address

6416 Deans Hill Rd
Berrien Center, MI 49102-9750
Phone (269) 471-7741

Other identifiers 2

IdentifierTypeStateIssuer
1538397120OtherMIGROUP NPI
MI2051OtherMIGROUP MEDICARE #

Other names 1

  • Lakeside Urology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Medical Practices49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 11

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": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1932493863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6416 DEANS HILL RD",
            "city": "BERRIEN CENTER",
            "state": "MI",
            "postal_code": "491029750",
            "telephone_number": "269-471-7741",
            "fax_number": "269-471-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 N SAINT JOSEPH AVE",
            "address_2": "SUITE 200",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202208",
            "telephone_number": "269-684-5447",
            "fax_number": "269-684-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-08",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "JANCIE",
        "authorized_official_title_or_position": "DIRECTOR, PRACTICE OPERATIONS",
        "authorized_official_telephone_number": "268-687-1152"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MI",
            "license": "4301036136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1538397120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE #",
            "identifier": "MI2051",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; 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.