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LAKESIDE AUDIOLOGY LLC
NPI 1417341280
Clinic/Center - Hearing and Speech in Fort Mill, SC

Active since March 19, 2015
870 GOLD HILL RD STE 104, FORT MILL, SC 29708(803) 620-8250(803) 638-6901 Get Directions Write a Review

NPPES record last updated: November 19, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 19, 2021, Dec 30, 2016 (2 updates tracked since 2016).

About Lakeside Audiology Llc NPPES

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

LAKESIDE AUDIOLOGY LLC (NPI 1417341280) is a healthcare organization registered as a hearing and speech in Fort Mill, South Carolina and active in the NPI registry since March 2015. The organization lists Kimberly Block, Doctor Of Audiology, as its authorized official.

NPPES Registry Identity

NPI1417341280
Entity TypeOrganization
Primary Taxonomy261QH0700X
Legal Business NameLAKESIDE AUDIOLOGY LLC
Location Address870 GOLD HILL RD STE 104Fort Mill, SC 29708-8988
Mailing Address870 Gold Hill Rd Ste 104Fort Mill, SC 29708-8988 · (803) 620-8250 · Fax (803) 638-6901
Phone(803) 620-8250
Fax(803) 638-6901
Organization SubpartNo
Authorized OfficialKimberly BlockDoctor Of Audiology · (803) 412-6789
Enumeration DateMarch 19, 2015
Last NPPES UpdateNovember 19, 20212 updates tracked since enumeration
NPPES CertifiedNovember 19, 2021
✔ NPI 1417341280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Hearing and SpeechAmbulatory Health Care Facilities
Taxonomy Code261QH0700X
Licenses✔ Licensed in SC · 4011✔ Licensed in NC · 9758
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability.
Also ListedAudiologistTaxonomy 231H00000X
Also ListedSpeech-Language PathologistTaxonomy 235Z00000X
870 GOLD HILL RD STE 104, Fort Mill, SC 29708
Open in Google Maps ↗

Other Identifiers 1

MedicaidSA1525SC

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 Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina 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)

Lakeside Audiology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Lakeside Audiology LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Kimberly Block, AU.D.
Qualified Audiologist
NPI 1831317767
870 GOLD HILL RD STE 104
Fort Mill, SC 29708
(803) 620-8250
✔ Accepts MedicareSame address
Meghan Jensen, AU.D.
Qualified Audiologist
NPI 1255484549
870 GOLD HILL RD SUITE 104
Fort Mill, SC 29708
(803) 620-8250
✔ Accepts MedicareSame address
Jenna Viditz-Ward, AUD
Qualified Audiologist
NPI 1093555716
870 GOLD HILL RD STE 104
Fort Mill, SC 29708
(803) 620-8250
Same address

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 Lakeside Audiology LLC's NPI number?

The NPI number for Lakeside Audiology LLC is 1417341280. It was assigned to this organization in the NPPES registry on March 19, 2015.

Where is Lakeside Audiology LLC located?

Lakeside Audiology LLC is located at 870 Gold Hill Rd Ste 104, Fort Mill, SC 29708. The listed phone number is (803) 620-8250.

What is Lakeside Audiology LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Hearing and Speech, with taxonomy code 261QH0700X.

Is Lakeside Audiology LLC enrolled in Medicare?

Yes. Lakeside Audiology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lakeside Audiology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Qualified Audiologist, reassign their Medicare billing to Lakeside Audiology 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. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Lakeside Audiology LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and Molina Healthcare list Lakeside Audiology 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 Lakeside Audiology LLC was last updated on November 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.