Individual provider Active NPI

Matthew Boaz Lake, MD

  • Anesthesiology Physician
  • Lebanon, NH
National Provider Identifier
1992192520
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101269652 Issued in VA
Practice address
1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000
Phone
(603) 650-6177
NPI assigned
Apr 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 18330 NH
Anesthesiology Physician 207L00000X 0101269652 VA Primary

Addresses

Primary practice location

1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000

Mailing address

1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200901002379 VA Practitioner - Anesthesiology 2365740545 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
West Virginia University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology of Virginia PCGroup PAC ID 6800790023, 514 clinicians

Practice addresses (Care Compare)

1305 Walt Whitman Rd
Suite 300
Melville, NY 11747-4300

1500 Commonwealth Ave
Williamsburg, VA 23185-5229
Phone (757) 585-2200

19455 Deerfield Ave
Suite 204
Leesburg, VA 20176-8102
Phone (703) 724-9950

500 J Clyde Morris Blvd
Newport News, VA 23601-1929
Phone (757) 594-2000

Hospital & facility affiliations

  • Riverside Regional Medical Center Hospital, Newport News, VA, CCN 490052
  • Riverside Doctors' Hospital of Williamsburg Hospital, Williamsburg, VA, CCN 490143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18330NHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Virginia PC Anesthesiology CurrentSince Nov 30, 2024 Accepting new patients
Northstar Anesthesia of Virginia, LLC Anesthesiology CurrentSince Oct 1, 2024 Accepting new patients
American Anesthesiology of Virginia, PC Anesthesiology CurrentSince Nov 30, 2024 Accepting new patients

Locations

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

736 Battlefield Blvd N
Chesapeake, VA 23320
Phone (757) 312-6124

541 Sunset Ln
Ste 201
Culpeper, VA 22701
Phone (540) 829-0700

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

Organizations & group practices 3

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

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": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1992192520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DHMC DEPT. OF ANESTHESIOLOGY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DHMC DEPT. OF ANESTHESIOLOGY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MATTHEW",
        "middle_name": "BOAZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NH",
            "license": "18330",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101269652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.