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LAKE CITY CANCER CARE LLC
NPI 1396132213
Internal Medicine - Hematology & Oncology in Lake City, FL

Active since April 17, 2015CLIA 10D2010828 · Waiver
289 SW STONEGATE TER, SUITE 103, LAKE CITY, FL 32024(386) 755-1655(386) 628-9231 Get Directions Write a Review

NPPES record last updated: May 20, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 20, 2026, Feb 2, 2026, Mar 14, 2023 (3 updates tracked since 2023).

About Lake City Cancer Care Llc NPPES

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

LAKE CITY CANCER CARE LLC (NPI 1396132213), doing business as Cancer Care Of North Florida & Urology Medical Of North Florida, is a healthcare organization registered as a hematology & oncology in Lake City, Florida and active in the NPI registry since April 2015. The organization holds a CLIA Waiver certificate valid through August 4, 2028, maintains a secondary practice location in Lake City, and lists Chaoqiang Lin, Executive Vice President & Cfo, as its authorized official.

NPPES Registry Identity

NPI1396132213
Entity TypeOrganization
Primary Taxonomy207RH0003X
Legal Business NameLAKE CITY CANCER CARE LLC
Location Address289 SW STONEGATE TER, SUITE 103Lake City, FL 32024-3456
Mailing Address289 Sw Stonegate Ter Ste 103Lake City, FL 32024-3457 · (386) 755-1655 · Fax (386) 628-9231
Phone(386) 755-1655
Fax(386) 628-9231
Organization SubpartNo
Authorized OfficialChaoqiang LinExecutive Vice President & Cfo · (214) 587-4079
Enumeration DateApril 17, 2015
Last NPPES UpdateMay 20, 20263 updates tracked since enumeration
NPPES CertifiedMay 20, 2026
✔ NPI 1396132213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians
Taxonomy Code207RH0003X
License✔ Licensed in FL · HCC10421
Definition
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
Also ListedRadiology · Radiation OncologyTaxonomy 2085R0001X · License HCC8414 (FL)
Also ListedUrologyTaxonomy 208800000X · License HCC10606 (FL)
289 SW STONEGATE TER, Lake City, FL 32024
Open in Google Maps ↗

Other Names 1

Doing Business AsCancer Care Of North Florida & Urology Medical Of North Florida

Secondary Practice Location 1

Location 14520 W US Highway 90Lake City, FL 32055-8341 · Phone (386) 755-0601 ext. 50601

Other Identifiers 1

Medicaid015614300FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.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)

Lake City Cancer Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Lake City Cancer Care LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 9 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 6

Nurse Practitioner4
Hematology/Oncology2
Radiation Oncology2
Medical Oncology1
Nuclear Medicine1
Urology1

Clinicians, nearest first (11)

Vernon Montoya, M.D.
Medical Oncology
NPI 1124019427
289 SW STONEGATE TERR SUITE #103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
Jessica Douglas, FNP-BC
Nurse Practitioner
NPI 1811376601
289 SW STONEGATE TER STE 103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
Brandi Hagmann, RN, FNP-BC
Nurse Practitioner
NPI 1790519189
289 SW STONEGATE TER STE 103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
Waseemullah Khan, MD
Hematology/Oncology
NPI 1073557864
289 SW STONEGATE TER SUITE103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
Nicholas Martino, APRN
Nurse Practitioner
NPI 1346010204
289 SW STONEGATE TER STE 103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
Sheila Roberts, ARNP
Nurse Practitioner
NPI 1750358073
289 SW STONEGATE TER SUITE 103
Lake City, FL 32024
(386) 755-1655
✔ PECOS✔ Accepts MedicareSame address
John Bergin, MD
Radiation Oncology
NPI 1073040382
4520 W US HIGHWAY 90
Lake City, FL 32055
(386) 755-0601
✔ PECOS✔ Accepts Medicare0.1 mi
Mark Thompson, D.O.
Radiation Oncology
NPI 1487646030
4520 W US HIGHWAY 90
Lake City, FL 32055
(352) 755-0601
✔ PECOS✔ Accepts Medicare0.1 mi
Eric Ordinario, D.O.
Urology
NPI 1871545301
4601 W US HIGHWAY 90
Lake City, FL 32055
(386) 752-4189
✔ PECOS✔ Accepts Medicare0.2 mi
Peter Acs, M.D.
Hematology/Oncology
NPI 1861445421
1500 SE MAGNOLIA EXT STE 205
Ocala, FL 34471
(352) 529-8232
✔ PECOS✔ Accepts Medicare78 mi
Amir Abdelmalik, MD
Nuclear Medicine
NPI 1093967390
601 N CAROLINE ST
Baltimore, MD 21287
(410) 955-9446
✔ PECOS✔ Accepts Medicare718 mi

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 10D2010828

Lake City Cancer Care LLC Dba Cancer Care Of North Florida · Lake City, FL
Active · expires Aug 4, 2028
CLIA Number10D2010828
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 5, 2026
Certificate Expiration DateAugust 4, 2028
Laboratory DirectorWaseemullah Khan
Laboratory Phone(386) 755-0601
Laboratory LocationLake City Cancer Care LLC Dba Cancer Care Of North Florida4520 W Us Hwy 90, Lake City, FL 32055
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Lake City Cancer Care LLC's NPI number?

The NPI number for Lake City Cancer Care LLC is 1396132213. It was assigned to this organization in the NPPES registry on April 17, 2015. The provider is doing business as Cancer Care of North Florida & Urology Medical of North Florida.

Where is Lake City Cancer Care LLC located?

Lake City Cancer Care LLC is located at 289 SW Stonegate Ter Suite 103, Lake City, FL 32024. The listed phone number is (386) 755-1655.

What is Lake City Cancer Care LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Is Lake City Cancer Care LLC enrolled in Medicare?

Yes. Lake City Cancer Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake City Cancer Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 6 Medicare specialties reassign their Medicare billing to Lake City Cancer Care 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. The largest specialties are Nurse Practitioner (4), Hematology/Oncology (2) and Radiation Oncology (2). Of these, 6 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lake City Cancer Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2010828) is associated with this NPI, valid through August 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lake City Cancer Care LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 37 other insurers list Lake City Cancer Care 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 Lake City Cancer Care LLC was last updated on May 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.