LAKESIDE FAMILY MEDICINE
NPI 1295064178
Family Medicine in Kingston, OK
About Lakeside Family Medicine NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKESIDE FAMILY MEDICINE (NPI 1295064178) is a healthcare organization registered as a family medicine in Kingston, Oklahoma and active in the NPI registry since December 2009. The organization holds a CLIA Waiver certificate valid through September 3, 2028 and lists Pamela E Ahearn, Owner/president, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lakeside Family Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Lakeside Family Medicine, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 37D2000831
Lakeside Family Medicine · Kingston, OKFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lakeside Family Medicine's NPI number?
The NPI number for Lakeside Family Medicine is 1295064178. It was assigned to this organization in the NPPES registry on December 23, 2009.
Where is Lakeside Family Medicine located?
Lakeside Family Medicine is located at 21 N. Main Street, Kingston, OK 73439. The listed phone number is (580) 226-1010.
What is Lakeside Family Medicine's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lakeside Family Medicine enrolled in Medicare?
Yes. Lakeside Family Medicine is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lakeside Family Medicine?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Lakeside Family Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4) and Internal Medicine (1). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lakeside Family Medicine hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 37D2000831) is associated with this NPI, valid through September 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Lakeside Family Medicine accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Lakeside Family Medicine as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Lakeside Family Medicine was last updated on December 23, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lakeside Family Medicine · NPI 1295064178
Family Medicine organization in Kingston, Oklahoma. Organization record, active in the CMS NPPES registry since December 23, 2009.
## Identity
- **NPI:** 1295064178 (Entity type: Organization)
- **Enumerated:** December 23, 2009
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Pamela Ahearn, OWNER/PRESIDENT
## Practice location
- **Address:** 21 N. MAIN STREET, Kingston, OK 73439-1798
- **Phone:** (580) 226-1010
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Internal Medicine (1); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 23, 2009
- **Other identifiers:** Medicaid PENDING (OK); Medicare PIN PENDING (OK)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1295064178) · Data from the CMS NPPES public registry.