LAKESHORE MEDICAL CLINIC, LLC
NPI 1114087053
Durable Medical Equipment & Medical Supplies in South Milwaukee, WI
NPI Status: Active since December 11, 2006
Contact Information
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI
ZIP 53172
Phone: (414) 762-7270
Fax: (414) 762-7864
- Organization
- Durable Medical Equipment & Medical Supp...
- CLIA Number: 52D0980686
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 11-29-2026
About LAKESHORE MEDICAL CLINIC, LLC
This page provides the complete NPI Profile along with additional information for Lakeshore Medical Clinic, Llc, a provider established in South Milwaukee, Wisconsin operating as a Durable Medical Equipment & Medical Supplies. The healthcare provider is registered in the NPI registry with number 1114087053 assigned on December 2006. The practitioner's primary taxonomy code is 332B00000X. The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is Gail Hanson (Cfo)
- NPI
- 1114087053
- Provider Name
- LAKESHORE MEDICAL CLINIC, LLC
- Entity Type
- Organization
- Location Address
- 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172
- Location Phone
- (414) 762-7270
- Location Fax
- (414) 762-7864
- Mailing Address
- 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172
- Mailing Phone
- (414) 762-7270
- Mailing Fax
- (414) 762-7864
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-11-2006
- Last Update Date
- 01-10-2017
- Code Navigator
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
Durable Medical Equipment & Medical Supplies
- Taxonomy Code
- 332B00000X
- Type
- Suppliers
- Taxonomy Description
- A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
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 |
|---|---|---|---|
| 0458040012 | MEDICARE NSC (07) | WI |
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
- 52D0980686
- Facility Type
- Physician Office
- Certificate Effective Date
- November 30, 2024
- Certificate Expiration Date
- November 29, 2026
- Laboratory Director
- DR. SANDHYA SUREDDI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Lakeshore Medical Clinic, Llc 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.
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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 | 1 | 1 | 4 | 0 | 8 | 7 | 0 | 5 | 3 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 2 | 4 | 0 | 8 | 14 | 0 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 2 + 4 + 0 + 8 + 1 + 4 + 0 + 1 + 0 + 24 = 47 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 47 = 3 | 3 | ||||||||
The NPI number 1114087053 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 8 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1154480820 | DR. JILL C LYONS DPT Individual | Physical Therapist | 3611 S CHICAGO AVE SUTIE 120 SOUTH MILWAUKEE, WI 53172 (414) 766-2440 |
| 1962579243 | DAVID J PENCIKOWSKI NP Individual | Nurse Practitioner | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-2450 |
| 1295837193 | JOHN P VIEAU PA Individual | Physician Assistant (Medical) | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
| 1659780229 | KATIE J RASMUSSEN PA-C Individual | Physician Assistant | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
| 1730488404 | DR. JILLIAN HUYCK HUDSON MD Individual | Family Medicine | 3611 S CHICAGO AVE SUITE 100 SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
| 1851896898 | PATRICK FOSS MD Individual | Family Medicine | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
| 1407435019 | DREW GUNDERSON MD Individual | Family Medicine | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
| 1124134655 | SANDHYA SUREDDI MD Individual | Internal Medicine | 3611 S CHICAGO AVE SOUTH MILWAUKEE, WI 53172 (414) 762-7270 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114087053, enumerated in the NPI registry as an "organization" on December 11, 2006
The provider is located at 3611 S Chicago Ave South Milwaukee, Wi 53172 and the phone number is (414) 762-7270
This medical organization specializes in Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 52D0980686 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 11, 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].
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