Lake City Primary Care PLLC
NPI 1164850053ActiveOrganization· Family Medicine· Plattsburgh, NY
Family Medicine in Plattsburgh, New York, registered in NPPES in October 2013. The authorized official on file is Kelley Brault, Office Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1164850053 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 31, 2013 |
| Last updated in NPPES | Jan 17, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 210018 | NY |
| Internal Medicine | 207R00000X | 210018 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NY) |
|---|
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