LAKE HOSPITAL SYSTEM INC (NPI# 1538101985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538101985 |
| Entity Type | Organization |
| Organization Name | LAKE HOSPITAL SYSTEM INC |
| Other Organization Name | PRIMEHEALTH CHARDON FAMILY PRACTICE |
| Practice Address |
510 Fifth Avenue Chardon OH 44024 |
| Mailing Address |
Po Box 714328 Columbus OH 43271-4328 |
| Practice Telephone | 4402791528 |
| Practice Fax Number | 4402791516 |
| Mailing Telephone | 8003541985 |
| Mailing Fax Number | 4403504938 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2007-09-06 |
| Authorized Official Name | MR. ROBERT TRACZ (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4403541051 |
| Is Organization Subpart | Y |
| Parent Organization Name | LAKE HOSPITAL SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2017294 | 05 |
| Other Name | Type Code |
|---|---|
| PrimeHealth Chardon Family Practice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518264043 | Lake Hospital System Inc | Clinic/Center | 2 Success Blvd, Perry, OH 44081-9404 | 2011-02-18 |
| 1164697629 | Lake Hospital System Inc | Internal Medicine | 2747 Som Center Rd, Willoughby, OH 44094-9164 | 2008-04-25 |
| 1952339996 | Lake Hospital System Inc | Surgery | 16030 E High St Ste 101, Middlefield, OH 44062-9474 | 2006-06-29 |
| 1366484818 | Lake Hospital System Inc | Family Medicine | 6990 Lindsay Dr, #3, Mentor, OH 44060-4981 | 2006-06-11 |
| 1912375601 | Lake Hospital System Inc | Pharmacy | 36000 Euclid Ave, Willoughby, OH 44094-4625 | 2015-09-11 |
| 1922390012 | Lake Hospital System Inc | Clinic/Center | 6067 N Ridge Rd, Madison, OH 44057-2441 | 2011-05-06 |
| 1851698435 | Lake Hospital System Inc | Nurse Practitioner | 7590 Auburn Rd, Concord Twp, OH 44077-9176 | 2011-02-17 |
| 1972689172 | Lake Hospital System Inc | Psychiatric Unit | 36000 Euclid Ave, Willoughby, OH 44094-4662 | 2006-10-31 |
| 1013951920 | Lake Hospital System Inc | Pediatrics | 9485 Mentor Ave, 101, Mentor, OH 44060 | 2006-06-15 |
| 1699719518 | Lake Hospital System Inc | Obstetrics & Gynecology | 35040 Chardon Rd, Bldg Vii #205, Willoughby Hills, OH 44094 | 2006-06-15 |
| Street Address |
510 FIFTH AVENUE |
| City | CHARDON |
| State | OH |
| Zip Code | 44024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912181595 | Lake Hospital System, Inc. | Pediatrics | 510 Fifth Avenue, Chardon, OH 44024 | 2007-12-19 |
| 1023225448 | Melanie J Malec | Family Medicine | 510 Fifth Avenue, Chardon, OH 44024 | 2007-05-16 |
| 1497861744 | Carol L Noall | Family Medicine | 510 Fifth Avenue, Chardon, OH 44024 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992336770 | Amanda Nicole Nelson | Technician, Other | 133 Up Main St, Chardon, OH 44024 | 2020-01-30 |
| 1679067011 | Janai Marshae Seng | Dentist | 401 South Street #3a, Chardon, OH 44024 | 2018-06-19 |
| 1376036475 | Kasandra Leigh Chapman | Social Worker | 12941 Ravenna Road, Chardon, OH 44024 | 2018-06-13 |
| 1275068652 | Danielle Tilton | Nurse Practitioner | 531 Fifth Ave, Chardon, OH 44024 | 2017-04-24 |
| 1881057040 | Erin Marie Moore | Counselor | 203 Main St., Chardon, OH 44024 | 2016-04-04 |
| 1649689886 | Hope Anne Super | Speech-Language Pathologist | 100 7th Av Suite 255, Chardon, OH 44024 | 2014-08-12 |
| 1740600022 | Elisha Tzvi Fredman | Student in an Organized Health Care Education/Training Program | 13207 Chardon Road, Ravenna, OH 44024 | 2014-04-24 |
| 1083039309 | Jamie Delvecchio | Family Medicine | 150 7th Ave Ste 200, Chardon, OH 44024 | 2014-02-24 |
| 1174947212 | Frank Scarano | Psychologist | 470 Center Street, Chardon, OH 44024 | 2014-02-10 |
| 1659706497 | Jamie Henderson | Physical Therapy Assistant | 9348 South Brown Rd, Chardon, OH 44024 | 2013-09-12 |
| Find all providers in zip 44024 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336212992 | Allison M Rogish | Family Medicine | 150 Seventh Ave Ste 110, Chardon, OH 44024-2909 | 2006-11-15 |
| 1144281288 | Robert Mark Znidarsic | Family Medicine | 510 Fifth Ave, Chardon, OH 44024 | 2006-03-29 |
| 1992791636 | Louis Dominick Leone | Family Medicine | 320 Center St, Chardon, OH 44024-1165 | 2005-09-27 |
| 1619978384 | Matthew Bernard Pawlicki | Family Medicine | 100 Seventh Ave Ste 111, Chardon, OH 44024-7802 | 2005-08-03 |
| 1225585748 | Malathi Amarnath | Family Medicine | 13207 Ravenna Rd, Chardon, OH 44024-7032 | 2016-09-01 |
| 1649531997 | Vadhya Elivert | Family Medicine | 13170 Ravenna Rd, Suite 108, Chardon, OH 44024-7025 | 2012-06-04 |
| 1861704140 | Timothy Richard Neely | Family Medicine | 510 5th Ave, Chardon, OH 44024-1076 | 2010-07-02 |
| 1023225448 | Melanie J Malec | Family Medicine | 510 Fifth Avenue, Chardon, OH 44024 | 2007-05-16 |
| 1356436679 | Louis Leone D.o. Inc. | Family Medicine | 320 Center St, Chardon, OH 44024-1165 | 2006-10-03 |
| 1497861744 | Carol L Noall | Family Medicine | 510 Fifth Avenue, Chardon, OH 44024 | 2006-08-21 |
| Find all providers in CHARDON | ||||
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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.