NPIMap

Organization Active NPI

Elite Medical Services at Lakeside LLC

  • Emergency Medicine Physician
  • Belle Glade, FL
National Provider Identifier
1992216568
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ELITE MEDICAL SERVICES AT LAKESIDE LLC
Practice address
Lakeside Medical Center Emergency Department
39200 Hooker Hwy
Belle Glade, FL 33430-5368
Phone
(561) 996-6571
NPI assigned
Oct 23, 2017
Last updated
Dec 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Authorized official

Name
Kenneth A Scheppke, MD
Title
President
Phone
(561) 436-2291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

Lakeside Medical Center Emergency Department
39200 Hooker Hwy
Belle Glade, FL 33430-5368

Mailing address

PO Box 12010
Daytona Beach, FL 32120-2010
Phone (386) 274-7800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180406001651 FL Part B Supplier - Clinic/Group Practice 8921361882 Receives reassigned benefits from 48 practitioners
Practice locations: Belle Glade, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513036800000",
    "number": "1992216568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12010",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321202010",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAKESIDE MEDICAL CENTER EMERGENCY DEPARTMENT",
            "address_2": "39200 HOOKER HWY",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334305368",
            "telephone_number": "561-996-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL SERVICES AT LAKESIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2017-12-12",
        "status": "A",
        "authorized_official_last_name": "SCHEPPKE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-436-2291",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belle Glade, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; 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.