Lake City Primary Care PC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LAKE CITY PRIMARY CARE PC

Practice address

1866 S Morey Rd
Lake City, MI 49651

Phone

(231) 908-8888

Fax

(833) 989-2153

NPI assigned

Jun 29, 2018

Organization subpart

No

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

Authorized official

Name

Jason Ball

Title

Office Manager

Phone

(231) 908-8888

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Lake City Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 238938

Legal name

LAKE CITY PRIMARY CARE PC

Doing business as

LAKE CITY PRIMARY CARE

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 21, 2022

Last certification

Mar 21, 2022

Ownership / control type

2B

Organization structure

CorporationProprietary

Enrollment address

1866 S Morey Rd
Lake City, MI 49651-9190

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21154/brand/1/csg/1/fhir/r4

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Christopher Michael Donzell, FNP-BC

  • Family Nurse Practitioner
  • Lake City, MI
  • NPI 1780932137

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership
• Gregory Lambourne, M.D.

  • Internal Medicine Physician
  • Lake City, MI
  • NPI 1598775850

  Corporate Director

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Michael Donzell, FNP-BC

  • Family Nurse Practitioner
  • Lake City, MI
  • NPI 1780932137
  Medicare reassignment Care Compare group NPD
• Ashley Rozeveld

  • Family Nurse Practitioner
  • Grant, MI
  • NPI 1518620293
  Medicare reassignment Care Compare group NPD
• Gregory Lambourne, M.D.

  • Internal Medicine Physician
  • Lake City, MI
  • NPI 1598775850
  Medicare reassignment NPD

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1952896151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1866 S MOREY RD",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "496519190",
            "telephone_number": "231-830-7282",
            "fax_number": "231-830-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 S MOREY RD",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "49651",
            "telephone_number": "231-908-8888",
            "fax_number": "833-989-2153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-29",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-908-8888"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "238938",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MI12315",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake City Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Louise Klein, OTR
• David Robert Kramp, P.T.
• Michael Francis Lahey, DDS
• Lake City Family Dentistry
• Lake City Family Dentistry
• Lake Life Afc LLC
• Lake to Lake Transportation LLC
• Gregory Lambourne, M.D.
• Joseph Matthew Liestenfeltz
• Jessica Jean Lindell, FNP-C

• Rural Health Clinic/Center in Lake City, MI
• Providers in Lake City, MI by specialty
• Rural Health Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.