LAKE SHORE PEDIATRICS, LTD
NPI 1003011628
Pediatrics in Lake Forest, IL

NPI Status: Active since June 15, 2007

Contact Information

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

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  • Organization
  • Pediatrics
  • CLIA Number: 14D0412983
  • CLIA Cert. Type: Waiver
  • CLIA Exp. Date: 08-05-2025

About LAKE SHORE PEDIATRICS, LTD

Lake Shore Pediatrics, Ltd is a pediatrician established in Lake Forest, Illinois operating as a Pediatrics. The healthcare provider is registered in the NPI registry with number 1003011628 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 4 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 Dr. Diane Wheeler Fondriest Md (Managing Partner)

NPI
1003011628
Provider Name
LAKE SHORE PEDIATRICS, LTD
Entity Type
Organization
Location Address
900 N WESTMORELAND RD SUITE 106 LAKE FOREST, IL 60045
Location Phone
(847) 615-4654
Location Fax
(847) 615-1708
Mailing Address
900 N WESTMORELAND RD SUITE 106 LAKE FOREST, IL 60045
Mailing Phone
(847) 615-4654
Mailing Fax
(847) 615-1708
Is Sole Proprietor?
N/A
Is Organization Subpart?
No
Enumeration Date
06-15-2007
Last Update Date
08-22-2020
Code Navigator

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.

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

Taxonomy Code
208000000X
Type
Allopathic & Osteopathic Physicians
License No.
36065837
License State
IL
Taxonomy Description
A 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.

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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. DIANE WHEELER FONDRIEST MD

Authorized Official Title
MANAGING 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 this NPI number is:

CLIA Number
14D0412983
Facility Type
Physician Office
Certificate Effective Date
August 06, 2023
Certificate Expiration Date
August 05, 2025
Certificate Type
Certificate of Waiver
Certificate Type Description
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.

Reviews for LAKE SHORE PEDIATRICS, LTD

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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.
1003011628
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
200301264
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 1 + 2 + 6 + 4 + 24 = 42
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 42 = 88

The NPI number 1003011628 is valid because the calculated check digit 8 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
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
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
1023046299 MELISSA HILB CPNP
Individual
Nurse Practitioner (Pediatrics)900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220
1639107832 AMY FITZPATRICK CPNP
Individual
Nurse Practitioner (Pediatrics)900 N WESTMORELAND RD SUITE 110
LAKE FOREST, IL 60045
(847) 295-1220

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003011628, enumerated in the NPI registry as an "organization" on June 15, 2007

The provider is located at 900 N Westmoreland Rd Suite 106 Lake Forest, Il 60045 and the phone number is (847) 615-4654

This medical organization specializes in Pediatrics with taxonomy code 208000000X

The provider's CLIA number is 14D0412983 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 June 15, 2007. 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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