1. Home
  2. Directory
  3. Illinois
  4. Addison
  5. Family Medicine
  6. NPI Profile

LAKE STREET FAMILY MEDICINE, LLC
NPI 1639204613
Family Medicine in Addison, IL

Active since February 22, 2007
220 E LAKE ST, SUITE 100, ADDISON, IL 60101(630) 516-0434(630) 516-0419 Get Directions Write a Review

NPPES record last updated: December 11, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Lake Street Family Medicine, Llc NPPES

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

LAKE STREET FAMILY MEDICINE, LLC (NPI 1639204613) is a healthcare organization registered as a family medicine in Addison, Illinois and active in the NPI registry since February 2007. The organization lists Brian Koecher, Physician, as its authorized official.

NPPES Registry Identity

NPI1639204613
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAKE STREET FAMILY MEDICINE, LLC
Location Address220 E LAKE ST, SUITE 100Addison, IL 60101-2887
Mailing Address220 E Lake St, Suite 100Addison, IL 60101-2887 · (630) 516-0434 · Fax (630) 516-0419
Phone(630) 516-0434
Fax(630) 516-0419
Organization SubpartNo
Authorized OfficialBrian KoecherPhysician · (630) 516-0434
Enumeration DateFebruary 22, 2007
Last NPPES UpdateDecember 11, 2012
✔ NPI 1639204613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
220 E LAKE ST, Addison, IL 60101
Open in Google Maps ↗

Other Identifiers 1

Medicare ID-Type Unspecified212461IL · Medicare Group Number

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

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 Street Family Medicine, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Lake Street Family Medicine, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Brian Koecher, D.O.
Family Practice
NPI 1134210834
220 E LAKE ST SUITE 100
Addison, IL 60101
(630) 516-0434
✔ PECOS✔ Accepts MedicareSame address
Ekta Ohri, D.O.
General Practice
NPI 1043301773
220 E LAKE ST SUITE 100
Addison, IL 60101
(630) 516-0434
✔ PECOS✔ Accepts MedicareSame 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 Lake Street Family Medicine, LLC's NPI number?

The NPI number for Lake Street Family Medicine, LLC is 1639204613. It was assigned to this organization in the NPPES registry on February 22, 2007.

Where is Lake Street Family Medicine, LLC located?

Lake Street Family Medicine, LLC is located at 220 E Lake St Suite 100, Addison, IL 60101. The listed phone number is (630) 516-0434.

What is Lake Street Family Medicine, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Lake Street Family Medicine, LLC enrolled in Medicare?

Yes. Lake Street Family Medicine, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake Street Family Medicine, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Lake Street Family Medicine, LLC, in Family Practice and General Practice. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Lake Street Family Medicine, LLC was last updated on December 11, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.