NPIMap

Organization Active NPI

Lake Hospital System Inc

  • Family Medicine Physician
  • Middlefield, OH
National Provider Identifier
1952339996
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKE HOSPITAL SYSTEM INC
Practice address
16030 E High St Ste 101
Middlefield, OH 44062-9474
Phone
(440) 632-0594
Fax
(440) 632-0596
NPI assigned
Jun 29, 2006
Last updated
Feb 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Authorized official

Name
Mr. Robert A Tracz
Title
Chief Financial Officer
Phone
(440) 354-1051

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Midwife 176B00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Obstetrics & Gynecology Physician 207V00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Pediatrics Physician 208000000X NU
Surgery Physician 208600000X NU
Obesity Medicine (Internal Medicine) Physician 207RB0002X NU

Addresses

Primary practice location

16030 E High St Ste 101
Middlefield, OH 44062-9474

Mailing address

PO Box 781389
Detroit, MI 48278-1389
Phone (800) 354-1985

Other practice location 1

7590 Auburn Rd
Concord Twp, OH 44077
Phone (440) 354-1956

Other practice location 2

5105 Som Center Rd Ste 202
Willoughby, OH 44094-4203
Phone (440) 953-5760

Other practice location 3

9485 Mentor Ave Ste 103
Mentor, OH 44060-8722
Phone (440) 205-5799

Other practice location 4

13170 Ravenna Rd Ste 200
Chardon, OH 44024-7022
Phone (844) 542-6363

Other practice location 5

8300 Tyler Blvd Ste 300
Mentor, OH 44060-4251
Phone (440) 205-1529

Other practice location 6

8300 Tyler Blvd Ste 102
Mentor, OH 44060-4251
Phone (440) 266-5000

Other practice location 7

36100 Euclid Ave Ste 320
Willoughby, OH 44094-4489
Phone (440) 951-1073

Other practice location 8

9500 Mentor Ave Ste 370
Mentor, OH 44060-8714
Phone (440) 946-4555

Other practice location 9

9500 Mentor Ave Ste 370
Mentor, OH 44060-8714
Phone (440) 946-4555

Other practice location 10

7551 Fredle Drive
Concord Twp, OH 44077
Phone (440) 350-9595

Other practice location 11

7580 Auburn Road
Suite 314
Concord Twp, OH 44077
Phone (440) 352-0646

Other practice location 12

320 Center Street
Chardon, OH 44024
Phone (440) 285-8585

Other identifiers 1

IdentifierTypeStateIssuer
2017301MedicaidOH

Other names 1

  • LHPG Endocrinology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000963 OH Part B Supplier - Clinic/Group Practice 6002713922 Receives reassigned benefits from 333 practitioners
40 other NPIs on this enrollment

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 39

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

View all 39

National Provider Directory

National Provider Directory

Locations

13170 Ravenna Rd
Ste 200
Chardon, OH 44024
Phone (844) 542-6363

320 Center St
Chardon, OH 44024
Phone (216) 285-4999

9485 Mentor Ave
Ste 103
Mentor, OH 44060
Phone (440) 205-5799

36100 Euclid Ave
Ste 120
Willoughby, OH 44094
Phone (216) 951-8360

36100 Euclid Ave
Ste 170
Willoughby, OH 44094
Phone (440) 602-6737

36100 Euclid Ave
Ste 240
Willoughby, OH 44094
Phone (216) 953-6294

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Health Beachwood Medical CenterBeachwood, OH, CCN 360367 Hospital 5% Or Greater Direct Ownership Interest (51%)
Operational/Managerial Control (100%)		 Jan 17, 2017
Jan 17, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • New Manna CLG, LLC

    dba Lake Health Beachwood Medical Center

    • General Acute Care Hospital
    • Beachwood, OH
    • NPI 1841789427

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 336

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 336

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1952339996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781389",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781389",
            "telephone_number": "800-354-1985",
            "fax_number": "440-350-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 E HIGH ST STE 101",
            "city": "MIDDLEFIELD",
            "state": "OH",
            "postal_code": "440629474",
            "telephone_number": "440-632-0594",
            "fax_number": "440-632-0596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7590 Auburn Rd",
            "address_purpose": "LOCATION",
            "city": "Concord Twp",
            "state": "OH",
            "postal_code": "44077",
            "country_code": "US",
            "telephone_number": "440-354-1956",
            "fax_number": "440-354-1845",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5105 Som Center Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Willoughby",
            "state": "OH",
            "postal_code": "440944203",
            "country_code": "US",
            "telephone_number": "440-953-5760",
            "fax_number": "440-953-5761",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9485 Mentor Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440608722",
            "country_code": "US",
            "telephone_number": "440-205-5799",
            "fax_number": "440-205-5798",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13170 Ravenna Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "440247022",
            "country_code": "US",
            "telephone_number": "844-542-6363",
            "fax_number": "440-279-4732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8300 Tyler Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440604251",
            "country_code": "US",
            "telephone_number": "440-205-1529",
            "fax_number": "440-205-0840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8300 Tyler Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440604251",
            "country_code": "US",
            "telephone_number": "440-266-5000",
            "fax_number": "440-266-5004",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36100 Euclid Ave Ste 320",
            "address_purpose": "LOCATION",
            "city": "Willoughby",
            "state": "OH",
            "postal_code": "440944489",
            "country_code": "US",
            "telephone_number": "440-951-1073",
            "fax_number": "440-951-1844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9500 Mentor Ave Ste 370",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440608714",
            "country_code": "US",
            "telephone_number": "440-946-4555",
            "fax_number": "440-357-5353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9500 Mentor Ave Ste 370",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440608714",
            "country_code": "US",
            "telephone_number": "440-946-4555",
            "fax_number": "440-357-5353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7551 Fredle Drive",
            "address_purpose": "LOCATION",
            "city": "Concord Twp",
            "state": "OH",
            "postal_code": "44077",
            "country_code": "US",
            "telephone_number": "440-350-9595",
            "fax_number": "440-357-1905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7580 Auburn Road",
            "address_2": "Suite 314",
            "address_purpose": "LOCATION",
            "city": "Concord Twp",
            "state": "OH",
            "postal_code": "44077",
            "country_code": "US",
            "telephone_number": "440-352-0646",
            "fax_number": "440-352-0648",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "320 Center Street",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "44024",
            "country_code": "US",
            "telephone_number": "440-285-8585",
            "fax_number": "440-285-3754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "TRACZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "440-354-1051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "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": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017301",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LHPG Endocrinology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Middlefield, OH

Sources for this page

Verify at the official NPI Registry.