LAKE SHORE PEDIATRICS, LTD NPI 1003011628

Pediatrics in Lake Forest, IL

NPI 1003011628 Organization Pediatrics CLIA Number 14D0412983 CLIA Certificate of Waiver

About LAKE SHORE PEDIATRICS, LTD

Lake Shore Pediatrics, Ltd is a pediatrician established in Lake Forest, Illinois specializing in pediatrics. The NPI number of Lake Shore Pediatrics, Ltd is 1003011628 and was assigned on June 2007. The practitioner's primary taxonomy code is 208000000X with license number 36065837 (IL). The provider is registered as an organization and their NPI record was last updated one year ago. Lake Shore Pediatrics, Ltd 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 Dr. Diane Wheeler Fondriest Md (Managing Partner)

A pediatrician like Lake Shore Pediatrics, Ltd 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.

The CLIA number of Lake Shore Pediatrics, Ltd is 14D0412983 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Lake Shore Pediatrics, Ltd 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.

NPI

1003011628

Provider NameLAKE SHORE PEDIATRICS, LTD
Provider Location Address900 N WESTMORELAND RD SUITE 106 LAKE FOREST, IL 60045
Provider Mailing Address900 N WESTMORELAND RD SUITE 106 LAKE FOREST, IL 60045
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date06-15-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code208000000X
ClassificationPediatrics
TypeAllopathic & Osteopathic Physicians
License No.36065837
License StateIL
Taxonomy DescriptionA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Business Address

LAKE SHORE PEDIATRICS, LTD
900 N WESTMORELAND RD
SUITE 106
LAKE FOREST, IL
ZIP 60045
Phone: (847) 615-4654
Fax: (847) 615-1708

Get Directions


Mailing Address

LAKE SHORE PEDIATRICS, LTD
900 N WESTMORELAND RD
SUITE 106
LAKE FOREST, IL
ZIP 60045
Phone: (847) 615-4654
Fax: (847) 615-1708



Authorized Official

Authorized Official NameDR. DIANE WHEELER FONDRIEST MD
Authorized Official TitleMANAGING PARTNER
Authorized Official Phone(847) 615-4654

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 the NPI number 1003011628 is:

CLIA Number14D0412983
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

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.

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1366437352 SHERI ROSS MD
Individual
Pediatrics900 N WESTMORELAND RD 106
LAKE FOREST, IL 60045
(847) 615-0700
1770578775 DAVID SALTZMAN MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 106
LAKE FOREST, IL 60045
(847) 615-0700
1144215146 MELANIE E GOODELL MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 106
LAKE FOREST, IL 60045
(847) 615-0700
1568457554 DIANE ELIZABETH FONDRIEST MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 106
LAKE FOREST, IL 60045
(847) 615-4654
1881689875 SUSAN SHEINKOP MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 106
LAKE FOREST, IL 60045
(847) 615-0700
1952396962 DEBORAH GAIL GULSON MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 106
LAKE FOREST, IL 60045
(847) 615-0700
1932199718 RILINA GHOSH MD
Individual
Pediatrics900 N WESTMORELAND RD STE 106
LAKE FOREST, IL 60045
(847) 615-0700
1376533166 RILEY M MINSTER MD
Individual
Pediatrics900 N WESTMORELAND RD STE 106
LAKE FOREST, IL 60045
(847) 615-0700
1336123884DR. GARY EDWARD SCHAFFEL M.D.
Individual
Internal Medicine900 N WESTMORELAND RD SUITE 104
LAKE FOREST, IL 60045
(847) 234-8100
1649255902LAKE FOREST OBSTETRICS GYNECOLOGY & INFERTILITY S.C.
Organization
Obstetrics & Gynecology900 N WESTMORELAND RD SUITE 228
LAKE FOREST, IL 60045
(847) 234-3860
1891770152DR. LIONEL J SCHEWITZ M.D.
Individual
Obstetrics & Gynecology (Gynecology)900 N WESTMORELAND RD SUITE 228
LAKE FOREST, IL 60045
(847) 234-3860
1942285689DR. DAVID C SCHEWITZ M.D.
Individual
Obstetrics & Gynecology900 N WESTMORELAND RD SUITE 228
LAKE FOREST, IL 60045
(847) 234-3860
1376520312 JAMES E DEVINE PHD
Individual
Psychologist (Clinical)900 N WESTMORELAND RD STE LL70
LAKE FOREST, IL 60045
(847) 295-0340
1235196858DR. MARK ALLAN BERK M.D.
Individual
Dermatology900 N WESTMORELAND RD SUITE 222
LAKE FOREST, IL 60045
(847) 234-6121
1306883756DR. ALLEN I KRISSBERG M.D.
Individual
Pediatrics900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220
1487694097DR. RICHARD P. MARTINO DDS
Individual
Dentist (Oral and Maxillofacial Pathology)900 N WESTMORELAND RD SUITE 208
LAKE FOREST, IL 60045
(847) 234-3390
1730121872DR. MICHAEL W TERKILDSEN M.D.
Individual
Pediatrics900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220
1770526220DR. BERNARD B PRITZKER M.D.
Individual
Pediatrics900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220
1215972799DR. GERALD LASIN MD
Individual
Pediatrics900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220
1659316768 DAWN RIBNEK
Individual
Nurse Practitioner (Pediatrics)900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.