Individual provider Active NPI

Lakin H Shostak, PAC

  • Physician Assistant
  • Fairfield, CT
National Provider Identifier
1952497091
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
000801 Issued in CT
Practice address
1305 Post Rd
#103
Fairfield, CT 06824
Phone
(203) 319-0700
NPI assigned
Oct 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000801 CT Primary

Addresses

Primary practice location

1305 Post Rd
#103
Fairfield, CT 06824

Mailing address

138 Figlar Ave
Fairfield, CT 06824
Phone (203) 255-5875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090422000007 CT Practitioner - Physician Assistant 9739236167 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians
Yale UniversityGroup PAC ID 9436061736, shared by 12 NPIs, 2,632 clinicians

Practice addresses (Care Compare)

226 Mill Hill Ave
Suite 3
Bridgeport, CT 06610-2826
Phone (203) 384-3976

247 Broad St
Milford, CT 06460-3273
Phone (203) 783-0543

95 Armory Rd
Stratford, CT 06614-1702
Phone (203) 384-3388

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
801CTMDOptician
000801CTMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Apr 1, 2009 Accepting new patients
Northeast Medical Group Inc CurrentSince Apr 1, 2009 Accepting new patients
Bridgeport Hospital CurrentSince Dec 31, 2013 Accepting new patients

Locations

226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394

267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170

1305 Post Rd
Ste 103
Fairfield, CT 06824
Phone (203) 319-0700

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: lshostak9821@direct.ynhh.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952497091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 FIGLAR AVE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06824",
            "telephone_number": "203-255-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 POST RD",
            "address_2": "#103",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06824",
            "telephone_number": "203-319-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOSTAK",
        "first_name": "LAKIN",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "000801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.