Lakeside Hospital Internal Medicine Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LAKESIDE HOSPITAL INTERNAL MEDICINE GROUP

Practice address

156 West Ave
Brockport, NY 14420-1229

Phone

(585) 395-6095

Fax

(585) 395-6036

NPI assigned

Jan 22, 2007

Organization subpart

No

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

Authorized official

Name

Rajendra Mehta, M.D.

Title

Partner

Phone

(585) 637-9196

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247529600000",
    "number": "1962555854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HOSPITAL INTERNAL MEDICINE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2009-07-14",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "RAJENDRA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "585-637-9196",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "G0181141590",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02198570",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "MG150",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Surgical Practice, PC
• Lakeside Anesthesia PLLC
• Lakeside Beikirch Care Center, Inc.
• Lakeside Health System
• Lakeside Health System Medical Services
• Lakeside Imaging, LLC
• Lakeside Memorial Hospital Inc
• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.

• Internal Medicine Physician in Brockport, NY
• Providers in Brockport, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2009; 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.