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

Active since September 12, 2016CLIA 13D2118549 · Waiver
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: August 09, 2026.

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

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 holds a CLIA Waiver certificate valid through September 8, 2026 and 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
Open in Google Maps ↗

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 Premera Blue Cross Blue Shield of Alaska.Insurance ›

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 13D2118549

Family Practice By The Lake LLC · Coeur D'alene, ID
Active · expires Sep 8, 2026
CLIA Number13D2118549
Laboratory TypePhysician Office
Certificate Effective DateSeptember 9, 2024
Certificate Expiration DateSeptember 8, 2026
Laboratory DirectorJacqueline Wagner
Laboratory Phone(208) 966-4087
Laboratory LocationFamily Practice By The Lake LLC1875 N Lakewood Dr Suite 205, Coeur D'alene, ID 83814
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JADA RICKHEIM ARNP
Nurse Practitioner (Family)
1875 N LAKEWOOD DR STE 205
COEUR D ALENE, ID 83814
Kootenai County (208) 966-4087

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.

Does Family Practice By The Lake LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2118549) is associated with this NPI, valid through September 8, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Family Practice By The Lake LLC accept?

Health plans from 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.