DR. LADD DANIEL LAKE (NPI# 1023076874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023076874 |
| Entity Type | Individual |
| Full Name | DR. LADD DANIEL LAKE |
| Credential | M.D. |
| Practice Address |
601 W Leota St North Platte NE 69101-6525 |
| Mailing Address |
Po Box 362 North Platte NE 69103-0362 |
| Practice Telephone | 3086967491 |
| Practice Fax Number | 3086967432 |
| Mailing Telephone | 8664777013 |
| Mailing Fax Number | 8669022445 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2016-05-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
22147 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | US DEPARTMENT OF LABOR | 605082700 | 01 |
| NE | BC/BS OF NEBRASKA | 04192 | 01 |
| IA | WELLMARK BC/BS | 20050 | 01 |
| NE | MIDLANDS CHOICE | 243897 | 01 |
| NE | 10025186700 | 05 | |
| IA | 0585794 | 05 | |
| NE | SHARE ADVANTAGE | 1603089 | 01 |
| Street Address |
601 W LEOTA ST |
| City | NORTH PLATTE |
| State | NE |
| Zip Code | 69101-6525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689672040 | Rick Allen Kukulka | Radiology | 601 W Leota St, North Platte, NE 69101-6525 | 2005-07-11 |
| 1669098687 | Jessie Rose Thorup | Physician Assistant | 601 W Leota St, North Platte, NE 69101-6525 | 2020-06-25 |
| 1447898408 | Shelby Rademacher | Nurse Practitioner | 601 W Leota St, North Platte, NE 69101-6525 | 2019-12-20 |
| 1952957102 | Cecelia Rae Opela-sierks | Nurse Practitioner | 601 W Leota St, North Platte, NE 69101-6525 | 2019-08-14 |
| 1295299204 | Alexander Donald Lucci | Nurse Anesthetist, Certified Registered | 601 W Leota St, North Platte, NE 69101-6525 | 2019-01-23 |
| 1679047708 | Marisa Adlesich | Physician Assistant | 601 W Leota St, North Platte, NE 69101-6525 | 2019-01-11 |
| 1689146128 | Jonathan Wade | Nurse Anesthetist, Certified Registered | 601 W Leota St, North Platte, NE 69101-6525 | 2018-12-21 |
| 1710452834 | Nicholas Singer | Nurse Anesthetist, Certified Registered | 601 W Leota St, North Platte, NE 69101-6525 | 2018-10-04 |
| 1932694346 | Elijah Samuel Vincent | Nurse Anesthetist, Certified Registered | 601 W Leota St, North Platte, NE 69101-6525 | 2018-06-27 |
| 1114418241 | Lisa Elizabeth Kopf | Physician Assistant | 601 W Leota St, North Platte, NE 69101-6525 | 2018-05-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972017523 | Rocky Mountain Holdings, LLC | Ambulance | 5570 E. Lee Bird Drive, Northe Platte, NE 69101 | 2017-11-18 |
| 1396297503 | Karen L Gutherless | Counselor | 401 W Walker Road, North Platte, NE 69101 | 2016-11-04 |
| 1992165898 | Laren Alden Roper Jr. | Occupational Therapist | 1115 S Cottonwood, Great Plains Sports and Therapy Center, North Platte, NE 69101 | 2016-03-04 |
| 1669733085 | Stephanie Lynn Marcy | Anesthesiology | 601 W Leota Street, Anes: Anesthesiology, North Platte, NE 69101 | 2012-06-01 |
| 1033480470 | Wb Counseling LLC | Counselor | 319 E. B St., North Platte, NE 69101 | 2012-01-17 |
| 1306114962 | Amy J Kloess | Occupational Therapist | 8165 North Twin Lakes Rd, North Platte, NE 69101 | 2011-12-09 |
| 1043442312 | Derek Walrod | Dentist | 1225 South Poplar, Suite 500, North Platte, NE 69101 | 2009-08-20 |
| 1033374525 | Millie Erickson | Urology | 611 W. Francis St., Suite 200, North Platte, NE 69101 | 2008-07-23 |
| 1952586331 | West Central District Health Department | Public Health or Welfare | 111 North Dewey Street, North Platte, NE 69101 | 2008-01-04 |
| 1558579698 | Piper Dental Clinic | Dentist | 1919 West A Street, North Platte, NE 69101 | 2007-05-21 |
| Find all providers in zip 69101 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689672040 | Rick Allen Kukulka | Radiology | 601 W Leota St, North Platte, NE 69101-6525 | 2005-07-11 |
| 1811069412 | Richard C. Cutshall | Radiology | 601 W Leota St, North Platte, NE 69101-6525 | 2006-11-15 |
| 1851476436 | Radiology Services, P.C. | Radiology | 601 W Leota St, North Platte, NE 69101-6525 | 2006-10-25 |
| 1407871908 | David Clark Hatch | Radiology | 601 W Leota St, North Platte, NE 69101-6525 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699384370 | Bryan Medical Center | Radiology | 3901 Pine Lake Rd Ste 110, Lincoln, NE 68516-5497 | 2020-07-28 |
| 1396368494 | Heartland Imaging Center of Hastings LLC | Radiology | 3203 Osborne Dr W Ste 102a, Hastings, NE 68901-9140 | 2020-05-22 |
| 1104319664 | Jackson Wyatt Boice | Radiology | S 42nd St and Emile St, Omaha, NE 68198-8500 | 2018-06-10 |
| 1396163135 | Bijal Shah | Radiology | S 42nd St & Emile St, Omaha, NE 68198-0001 | 2014-03-30 |
| 1164845202 | Diagnostic Radiology Bellevue Office | Radiology | 2510 Bellevue Medical Center Dr Ste 145, Bellevue, NE 68123-1556 | 2014-01-26 |
| 1417198995 | Guy Neil Gibson | Radiology | 905 S 110th Plz, Omaha, NE 68154-3370 | 2009-03-13 |
| 1235312257 | James F Johnson | Radiology | 9847 Bloomfield Dr, Omaha, NE 68114-2117 | 2007-12-12 |
| 1114126802 | Julie Ann Ratino | Radiology | 301 N. 60th Street, Omaha, NE 68131 | 2007-07-13 |
| 1700088028 | Matthew Mendlick | Radiology | 16116 Bedford Ave, Omaha, NE 68116-6433 | 2007-05-31 |
| 1700095452 | Roger Kent Harned | Radiology | 12624 Martha St, Omaha, NE 68144-2626 | 2007-05-21 |
| Find all providers with the same taxonomy | ||||
| City | NORTH PLATTE |
| Zip Code | 69101 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.