LAKESIDE MEDICAL
NPI 1528204922
General Practice in Salt Lake City, UT
NPI Status: Active since January 06, 2009
Contact Information
4701 W 2100 S
BUILDING 3
SALT LAKE CITY, UT
ZIP 84120
Phone: (801) 974-3382
Fax: (801) 974-3295
- Organization
- General Practice
- CLIA Number: 46D1011670
- CLIA Cert. Type: School/Student Health Service
- CLIA Exp. Date: 08-07-2026
About LAKESIDE MEDICAL
This page provides the complete NPI Profile along with additional information for Lakeside Medical, a primary care provider established in Salt Lake City, Utah operating as a General Practice. The healthcare provider is registered in the NPI registry with number 1528204922 assigned on January 2009. The practitioner's primary taxonomy code is 208D00000X with license number 151129-1205 (UT). The provider is registered as an organization and their NPI record was last updated 18 years ago. Lakeside Medical operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Lakeside Medical. The authorized official of this NPI record is Dr. Erik Moll D.c. (Medical Director)
- NPI
- 1528204922
- Provider Legal Name
- COMPREHENSIVE FAMILY CLINIC
- Other Organization Name
- LAKESIDE MEDICAL
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4701 W 2100 S BUILDING 3 SALT LAKE CITY, UT 84120
- Location Phone
- (801) 974-3382
- Location Fax
- (801) 974-3295
- Mailing Address
- 4701 W 2100 S BUILDING 3 SALT LAKE CITY, UT 84120
- Mailing Phone
- (801) 974-3382
- Mailing Fax
- (801) 974-3295
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 01-06-2009
- Last Update Date
- 01-07-2009
- Code Navigator
A primary care provider (PCP) like Lakeside Medical sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
General Practice
- Taxonomy Code
- 208D00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 151129-1205
- License State
- UT
- Taxonomy Description
- A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 111N00000X | Chiropractic Providers | Chiropractor | 6787397-1202 (UT) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 46D1011670
- Facility Type
- School/Student Health Service
- Certificate Effective Date
- August 08, 2024
- Certificate Expiration Date
- August 07, 2026
- Laboratory Director
- DARREN SORENSEN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Lakeside Medical to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1528204922, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 68 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1528204922, enumerated as an "organization" on January 06, 2009.
The provider is located at 4701 W 2100 S BUILDING 3 SALT LAKE CITY, UT 84120 and the phone number is (801) 974-3382.
General Practice with taxonomy code 208D00000X.
