FAMILY PRACTICE BY THE LAKE LLC
NPI 1295283810
Family Medicine in Coeur D Alene, ID

Q: What is Family Practice By The Lake LLC's NPI number?

The NPI number for Family Practice By The Lake LLC is 1295283810. It was assigned to this organization in the NPPES registry on September 12, 2016.

Q: What is Family Practice By The Lake LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since September 12, 2016

1875 N LAKEWOOD DR STE 205, COEUR D ALENE, ID 83814(208) 966-4087(208) 966-4031 Get Directions Write a Review

NPPES record last updated: March 25, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 12, 2020, Sep 12, 2016 (2 updates tracked since 2016).

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About Family Practice By The Lake Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAMILY PRACTICE BY THE LAKE LLC (NPI 1295283810) is a healthcare organization registered as a family medicine in Coeur D Alene, Idaho and active in the NPI registry since September 2016. The organization lists Jacqueline Lee Wagner, Owner, as its authorized official.

NPPES Registry Identity

NPI1295283810

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameFAMILY PRACTICE BY THE LAKE LLC

Location Address1875 N LAKEWOOD DR STE 205Coeur D Alene, ID 83814-4928

Mailing Address1875 N Lakewood Dr Ste 205Coeur D Alene, ID 83814-4928 · (208) 966-4087 · Fax (208) 966-4031

Phone(208) 966-4087

Fax(208) 966-4031

Organization SubpartNo

Authorized OfficialJacqueline Lee WagnerOwner · (208) 661-1181

Enumeration DateSeptember 12, 2016

Last NPPES UpdateMarch 25, 20242 updates tracked since enumeration

NPPES CertifiedMarch 25, 2024

✔ NPI 1295283810 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedNurse PractitionerTaxonomy 363L00000X

1875 N LAKEWOOD DR STE 205, Coeur D Alene, ID 83814

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, Premera Blue Cross Blue Shield of Alaska.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)

Family Practice By The Lake Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Family Practice By The Lake LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jacqueline Wagner, ARNP

Nurse Practitioner

NPI 1447598362

1713 E SHERMAN AVE
Coeur D Alene, ID 83814

(208) 966-4087

✔ PECOS✔ Accepts Medicare2.5 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently 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 Family Practice By The Lake LLC's NPI number?

The NPI number for Family Practice By The Lake LLC is 1295283810. It was assigned to this organization in the NPPES registry on September 12, 2016.

Where is Family Practice By The Lake LLC located?

Family Practice By The Lake LLC is located at 1875 N Lakewood Dr Ste 205, Coeur D Alene, ID 83814. The listed phone number is (208) 966-4087.

What is Family Practice By The Lake LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Family Practice By The Lake LLC enrolled in Medicare?

Yes. Family Practice By The Lake LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Family Practice By The Lake LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Family Practice By The Lake LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Family Practice By The Lake LLC accept?

Health plans from Molina Healthcare and Premera Blue Cross Blue Shield of Alaska list Family Practice By The Lake LLC 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 Family Practice By The Lake LLC was last updated on March 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.