LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
NPI 1003975087
Pediatrics - Adolescent Medicine in Coeur D'alene, ID
NPI Status: Active since December 06, 2006
Contact Information
980 W IRONWOOD DR
STE 302
COEUR D'ALENE, ID
ZIP 83814
Phone: (208) 292-5437
Fax: (208) 292-5441
- Organization
- Pediatrics
- Adolescent Medicine
- Accepts Insurance
- CLIA Number: 13D1004948
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-14-2026
About LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
This page provides the complete NPI Profile along with additional information for Lakeside Pediatric & Adolescent Medicine, Pllc, a pediatrician established in Coeur D'alene, Idaho operating as a Pediatrics, focusing in adolescent medicine . The healthcare provider is registered in the NPI registry with number 1003975087 assigned on December 2006. The practitioner's primary taxonomy code is 2080A0000X. The provider is registered as an organization and their NPI record was last updated 13 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Diana R Vanhook (Office Manager)
- NPI
- 1003975087
- Provider Name
- LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
- Entity Type
- Organization
- Location Address
- 980 W IRONWOOD DR STE 302 COEUR D'ALENE, ID 83814
- Location Phone
- (208) 292-5437
- Location Fax
- (208) 292-5441
- Mailing Address
- 980 W IRONWOOD DR STE 302 COEUR D'ALENE, ID 83814
- Mailing Phone
- (208) 292-5437
- Mailing Fax
- (208) 292-5441
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-06-2006
- Last Update Date
- 07-12-2012
- Code Navigator
A pediatrician like Lakeside Pediatric & Adolescent Medicine, Pllc is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics Adolescent Medicine
- Taxonomy Code
- 2080A0000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Connect Bronze Expanded Standard - PPO
- Connect Bronze HDHP - PPO
- Connect Catastrophic - PPO
- Connect Gold - PPO
- Connect Gold Standard - PPO
- Connect Silver - PPO
- Connect Silver Standard - PPO
- High Plains Bronze HDHP - PPO
- High Plains Bronze Standard Expanded - PPO
- High Plains Gold - PPO
- High Plains Gold HDHP - PPO
- High Plains Gold Standard - PPO
- High Plains Silver - PPO
- High Plains Silver Standard - PPO
- Plus Bronze Expanded - PPO
- Plus Bronze Standard Expanded - PPO
- Plus Gold - PPO
- Plus Gold Standard - PPO
- Plus Silver Standard - PPO
- ACCESS BRONZE - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 806408200 | MEDICAID (05) | ID | |
| 4010138351 | OTHER (01) | ID | REGENCE BLUE SHIELD GROUP |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D1004948
- Facility Type
- Physician Office
- Certificate Effective Date
- December 15, 2024
- Certificate Expiration Date
- December 14, 2026
- Laboratory Director
- JEAN PRINCE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Lakeside Pediatric & Adolescent Medicine, Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 0 | 3 | 9 | 7 | 5 | 0 | 8 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 18 | 7 | 10 | 0 | 16 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 1 + 8 + 7 + 1 + 0 + 0 + 1 + 6 + 24 = 53 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 53 = 7 | 7 | ||||||||
The NPI number 1003975087 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1699704759 | ELLEN KAY ROCK ARNP Individual | Nurse Practitioner (Family) | 980 W IRONWOOD DR SUITE 304 COEUR D ALENE, ID 83814 (208) 765-4888 |
| 1265549968 | MARSTON THORN WESTBROOK DDS Individual | Dentist (Oral and Maxillofacial Surgery) | 980 W IRONWOOD DR SUITE 301 COEUR D ALENE, ID 83814 (208) 664-0844 |
| 1215071469 | MATTHEW DAVID MCLAUGHLIN D.O. Individual | Urology | 980 W IRONWOOD DR STE 104 COEUR D ALENE, ID 83814 (208) 667-0621 |
| 1629284732 | DR. CHAD ALLAN PETERSON M.D. Individual | Urology | 980 W IRONWOOD DR STE. 104 COEUR D ALENE, ID 83814 (208) 667-0621 |
| 1255509410 | APPLE FAMILY CARE PLLC Organization | Family Medicine | 980 W IRONWOOD DR SUITE 201 COEUR D ALENE, ID 83814 (208) 292-1315 |
| 1518123660 | MRS. KATIE RENEE' KNAPP CMPCB Individual | Massage Therapist | 980 W IRONWOOD DR STE 101 COEUR D ALENE, ID 83814 (208) 704-3859 |
| 1851545628 | MS. KATHYRN ANN SUMNER KELSO LCPC Individual | Counselor (Professional) | 980 W IRONWOOD DR SUITE 101 COEUR D ALENE, ID 83814 (208) 765-1455 |
| 1114161551 | MARSTON T WESTBROOK , DDS, LLC Organization | Dentist (Oral and Maxillofacial Surgery) | 980 W IRONWOOD DR SUITE 301 COEUR D ALENE, ID 83814 (208) 664-0844 |
| 1477552008 | MRS. JEAN MARIE PRINCE MD Individual | Pediatrics | 980 W IRONWOOD DR STE 302 COEUR D ALENE, ID 83814 (208) 292-5437 |
| 1730188210 | DR. RONDA WESTCOTT M.D. Individual | Pediatrics | 980 W IRONWOOD DR STE 302 COEUR D ALENE, ID 83814 (208) 292-5437 |
| 1700821584 | BRIAN J. HICKOK MD Individual | Pediatrics | 980 W IRONWOOD DR STE 302 COEUR D ALENE, ID 83814 (208) 292-5437 |
| 1689719601 | MARTI D STOW FNP Individual | Nurse Practitioner (Family) | 980 W IRONWOOD DR SUITE 104 COEUR D ALENE, ID 83814 (208) 667-0621 |
| 1417270158 | CHRISTY L RILEY MD Individual | Pediatrics | 980 W IRONWOOD DR SUITE 302 COEUR D ALENE, ID 83814 (208) 292-5437 |
| 1144408618 | MR. STEVEN I JESSUP M.A. LIC. ATC Individual | Specialist/Technologist (Athletic Trainer) | 980 W IRONWOOD DR SUITE 207 COEUR D ALENE, ID 83814 (208) 770-2971 |
| 1265413017 | MR. FREDRICK MARK OWSLEY M.D. Individual | Specialist | 980 W IRONWOOD DR STE 206 COEUR D ALENE, ID 83814 (208) 664-0165 |
| 1689603847 | ANDREW ANTHONY HENNEBERG MD Individual | Obstetrics & Gynecology | 980 W IRONWOOD DR SUITE 201 COEUR D ALENE, ID 83814 (208) 765-4888 |
| 1114956216 | ROY RANDEL HENNEBERG MD Individual | Specialist | 980 W IRONWOOD DR SUITE 304 COEUR D ALENE, ID 83814 (208) 765-4888 |
| 1891717088 | JOHN J KIM M.D. Individual | Obstetrics & Gynecology | 980 W IRONWOOD DR SUITE 304 COEUR D ALENE, ID 83814 (208) 765-4888 |
| 1619110822 | DR. KEVIN JAY SCHULTZ MD Individual | Obstetrics & Gynecology | 980 W IRONWOOD DR SUITE 304 COEUR D ALENE, ID 83814 (208) 765-4888 |
| 1225884901 | MRS. SUZANNE KALEN EPPERSON ARNP-CNM Individual | Midwife | 980 W IRONWOOD DR COEUR D ALENE, ID 83814 (208) 765-4888 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1003975087, enumerated in the NPI registry as an "organization" on December 06, 2006
The provider is located at 980 W Ironwood Dr Ste 302 Coeur D'alene, Id 83814 and the phone number is (208) 292-5437
This medical organization specializes in Pediatrics with taxonomy code 2080A0000X with a focus in Adolescent Medicine
The provider might be accepting Accepts: Mountain Health CO-OP, Medicare, Medicaid and Blue. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 13D1004948 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on December 06, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.