NPIMap

Organization Active NPI

Lake Gastroenterology Associates LLC

  • Gastroenterology Physician
  • Tavares, FL
National Provider Identifier
1972801827
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LAKE GASTROENTEROLOGY ASSOCIATES LLC
Practice address
1703 Mayo Dr
Tavares, FL 32778-4307
Phone
(352) 383-5200
Fax
(352) 383-3534
NPI assigned
Mar 2, 2011
Last updated
May 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Soundarapandian Baskar, MDNPI 1952390288
Title
Owner/Officer
Phone
(352) 636-3652

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

1703 Mayo Dr
Tavares, FL 32778-4307

Mailing address

PO Box 1345
Mount Dora, FL 32756-1345
Phone (352) 383-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110502000725 FL Part B Supplier - Clinic/Group Practice 3173708484 Receives reassigned benefits from 12 practitioners
Practice locations: Leesburg, FL; Wildwood, FL; Tavares, FL; The Villages, FL

National Provider Directory

National Provider Directory

Locations

33049 Professional Dr
Ste 10
Leesburg, FL 34788

33049 Professional Dr
Ste 103
Leesburg, FL 34788
Phone (352) 353-6967

620 S Lake St
Ste 5
Leesburg, FL 34748
Phone (352) 383-5200

1703 Mayo Dr
Tavares, FL 32778
Phone (352) 383-5200

1858 Mayo Dr
Tavares, FL 32778
Phone (352) 383-5200

1305 Cleveland Ave
Wildwood, FL 34785
Phone (352) 365-0099

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1972801827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1345",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327561345",
            "telephone_number": "352-383-5200",
            "fax_number": "352-383-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 MAYO DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784307",
            "telephone_number": "352-383-5200",
            "fax_number": "352-383-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE GASTROENTEROLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "BASKAR",
        "authorized_official_first_name": "SOUNDARAPANDIAN",
        "authorized_official_title_or_position": "OWNER/OFFICER",
        "authorized_official_telephone_number": "352-636-3652",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tavares, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.