LAKE FOREST MEDICAL GROUP, INC.
NPI 1558429092
Family Medicine in Lake Forest, CA
About Lake Forest Medical Group, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE FOREST MEDICAL GROUP, INC. (NPI 1558429092) is a healthcare organization registered as a family medicine in Lake Forest, California and active in the NPI registry since December 2006. The organization holds a CLIA Microscopy certificate valid through December 24, 2027 and lists John C Koumas, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake Forest Medical Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Lake Forest Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Lake Forest, CA 92630
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 for Provider-Performed Microscopy Procedures (PPMP) 05D0717353
Lake Forest Med Group Inc · Lake Forest, CAFrequently 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 Forest Medical Group, Inc.'s NPI number?
The NPI number for Lake Forest Medical Group, Inc. is 1558429092. It was assigned to this organization in the NPPES registry on December 5, 2006.
Where is Lake Forest Medical Group, Inc. located?
Lake Forest Medical Group, Inc. is located at 24401 Muirlands Blvd Suite #a, Lake Forest, CA 92630. The listed phone number is (949) 770-1950.
What is Lake Forest Medical Group, Inc.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lake Forest Medical Group, Inc. enrolled in Medicare?
Yes. Lake Forest Medical Group, Inc. is registered in the Medicare PECOS enrollment system.
When is Lake Forest Medical Group, Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lake Forest Medical Group, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Lake Forest Medical Group, 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lake Forest Medical Group, Inc. hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D0717353) is associated with this NPI, valid through December 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Lake Forest Medical Group, Inc. was last updated on September 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.
# Lake Forest Medical Group, Inc. · NPI 1558429092
Family Medicine organization in Lake Forest, California. Organization record, active in the CMS NPPES registry since December 5, 2006.
## Identity
- **NPI:** 1558429092 (Entity type: Organization)
- **Enumerated:** December 5, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** John Koumas, OWNER
## Practice location
- **Address:** 24401 MUIRLANDS BLVD, SUITE #A, Lake Forest, CA 92630-3948
- **Phone:** (949) 770-1950 · **Fax:** (949) 770-8599
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Family Practice) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 17, 2008
- **Other identifiers:** Medicare UPIN C64510 (CA); Medicare UPIN E97960 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1558429092) · Data from the CMS NPPES public registry.