PRIMEHEALTH INTERNAL MEDICINE WILLOUGHBY
NPI 1417991332
Internal Medicine in Willoughby, OH

Q: What is Lake Hospital System Inc's NPI number?

The NPI number for Lake Hospital System Inc is 1417991332. It was assigned to this organization in the NPPES registry on June 15, 2006. The provider is also known as Primehealth Internal Medicine Willoughby.

Q: What is Lake Hospital System Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since June 15, 2006

36100 EUCLID AVE, #240, WILLOUGHBY, OH 44094(440) 918-4679(440) 918-4687 Get Directions Write a Review

NPPES record last updated: September 6, 2007. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Primehealth Internal Medicine Willoughby NPPES

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

PRIMEHEALTH INTERNAL MEDICINE WILLOUGHBY (NPI 1417991332) is a healthcare organization registered as an internal medicine in Willoughby, Ohio and active in the NPI registry since June 2006. The organization lists Robert Tracz, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1417991332

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameLAKE HOSPITAL SYSTEM INC

Location Address36100 EUCLID AVE, #240Willoughby, OH 44094

Mailing AddressPo Box 714328Columbus, OH 43271-4328 · (800) 354-1985 · Fax (440) 350-4938

Phone(440) 918-4679

Fax(440) 918-4687

Organization SubpartYesParent: Lake Hospital System, Inc.

Authorized OfficialRobert TraczChief Financial Officer · (440) 354-1051

Enumeration DateJune 15, 2006

Last NPPES UpdateSeptember 6, 2007

✔ NPI 1417991332 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

36100 EUCLID AVE, Willoughby, OH 44094

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Other Names 1

Other NamePrimehealth Internal Medicine Willoughby

Other Identifiers 2

Medicare PINLA9368241OH

Medicaid2017285OH

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 SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health.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)

Primehealth Internal Medicine Willoughby is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

284

Medicare enrollment records show 284 clinicians reassign Medicare billing to Primehealth Internal Medicine Willoughby, which bills Medicare for the services they deliver. Of these, 18 practice at this address and 159 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 29

Nurse Practitioner115

Family Practice51

Internal Medicine20

Obstetrics/Gynecology16

Neurology12

General Surgery10

Pediatric Medicine10

Cardiovascular Disease (Cardiology)7

21 other specialties43

Nearest to this location (20)

See all 284

Laura Bailey, MD

Internal Medicine

NPI 1770699019

36100 EUCLID AVE #240
Willoughby, OH 44094

(440) 953-6294

✔ PECOS✔ Accepts MedicareSame address

Aviv Ben Meir, M.D.

General Surgery

NPI 1417028556

36100 EUCLID AVE STE 170
Willoughby, OH 44094

(440) 602-6737

✔ PECOSSame address

Dail Ciani, NP-C

Nurse Practitioner

NPI 1700219292

36100 EUCLID AVENUE SUITE 170
Willoughby, OH 44094

(440) 602-6737

✔ PECOS✔ Accepts MedicareSame address

Christopher Daugherty, M.D.

Ophthalmology

NPI 1770926818

36100 EUCLID AVE STE 450
Willoughby, OH 44094

(440) 946-9555

✔ PECOS✔ Accepts MedicareSame address

Timothy Doyle, MD

Cardiovascular Disease (Cardiology)

NPI 1861451403

36100 EUCLID AVE SUITE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOSSame address

Olivia Engle

Nurse Practitioner

NPI 1245922202

36100 EUCLID AVE STE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOS✔ Accepts MedicareSame address

Alexandrea Fistek

Nurse Practitioner

NPI 1760116206

36100 EUCLID AVE STE 170
Willoughby, OH 44094

(440) 602-6737

✔ PECOS✔ Accepts MedicareSame address

Dennis Jurcevic, M.D.

Sleep Medicine

NPI 1780847632

36100 EUCLID AVE SUITE 210
Willoughby, OH 44094

(440) 602-6770

✔ PECOS✔ Accepts MedicareSame address

Sandeep Kotak, MD

Internal Medicine

NPI 1013023357

36100 EUCLID AVE STE 240
Willoughby, OH 44094

(440) 953-6294

✔ PECOS✔ Accepts MedicareSame address

Nancy Lazarescu, D.O.

Internal Medicine

NPI 1548463227

36100 EUCLID AVE SUITE 240
Willoughby, OH 44094

(440) 953-6294

✔ PECOS✔ Accepts MedicareSame address

Nicolas Marchinchin, C.N.P.

Nurse Practitioner

NPI 1255984886

36100 EUCLID AVE STE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOS✔ Accepts MedicareSame address

Colleen Nawrocki, CNP

Nurse Practitioner

NPI 1437236460

36100 EUCLID AVENUE SUITE 210
Willoughby, OH 44094

(440) 602-6770

✔ PECOSSame address

Michele Petruccelli

Nurse Practitioner

NPI 1538521000

36100 EUCLID AVENUE SUITE 240
Willoughby, OH 44094

(440) 953-6294

✔ PECOSSame address

John Samsa, DO

Cardiovascular Disease (Cardiology)

NPI 1932168242

36100 EUCLID AVE SUITE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOS✔ Accepts MedicareSame address

Marc Schrode, DO

Cardiovascular Disease (Cardiology)

NPI 1790713923

36100 EUCLID AVE SUITE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOS✔ Accepts MedicareSame address

Michelle Spech Holderbaum, MD

Internal Medicine

NPI 1851407167

36100 EUCLID AVE #240
Willoughby, OH 44094

(440) 953-6294

✔ PECOS✔ Accepts MedicareSame address

Paul Zellers, DO

Cardiovascular Disease (Cardiology)

NPI 1225263528

36100 EUCLID AVE STE 120
Willoughby, OH 44094

(440) 951-8360

✔ PECOS✔ Accepts MedicareSame address

Martin Mandel, M.D.

Endocrinology

NPI 1649238395

36100 EUCLID AVE SUITE 320
Willoughby, OH 44094

(440) 951-1073

✔ PECOSSame address

Iola Pustelnick, C.N.M.

Certified Nurse Midwife (CNM)

NPI 1275566556

36001 EUCLID AVE STE C7
Willoughby, OH 44094

(440) 602-6710

✔ PECOS✔ Accepts Medicare0.1 mi

Sherry Clemente, CNP

Nurse Practitioner

NPI 1528494531

36060 EUCLID AVE SUITE 204
Willoughby, OH 44094

(440) 602-6553

✔ PECOS✔ Accepts Medicare0.1 mi

See all 284 clinicians

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 Lake Hospital System Inc's NPI number?

The NPI number for Lake Hospital System Inc is 1417991332. It was assigned to this organization in the NPPES registry on June 15, 2006. The provider is also known as Primehealth Internal Medicine Willoughby.

Where is Lake Hospital System Inc located?

Lake Hospital System Inc is located at 36100 Euclid Ave #240, Willoughby, OH 44094. The listed phone number is (440) 918-4679.

What is Lake Hospital System Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Lake Hospital System Inc enrolled in Medicare?

Yes. Lake Hospital System Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake Hospital System Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 284 clinicians in 29 Medicare specialties reassign their Medicare billing to Lake Hospital System Inc. 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 (115), Family Practice (51) and Internal Medicine (20). Of these, 18 practice at this address and 159 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Lake Hospital System Inc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter from Meridian list Lake Hospital System Inc 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 Hospital System Inc was last updated on September 6, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.