1. Home
  2. Directory
  3. Ohio
  4. Willowick
  5. Family Medicine
  6. NPI Profile

PRIMEHEALTH SPORTS MEDICINE
NPI 1639315062
Family Medicine - Sports Medicine in Willowick, OH

Active since January 07, 2009
29804 LAKESHORE BLVD, WILLOWICK, OH 44095(440) 354-1899(440) 354-1089 Get Directions Write a Review

NPPES record last updated: January 7, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Primehealth Sports Medicine NPPES

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

PRIMEHEALTH SPORTS MEDICINE (NPI 1639315062) is a healthcare organization registered as a sports medicine in Willowick, Ohio and active in the NPI registry since January 2009. The organization lists Robert Tracz, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1639315062
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameLAKE HOSPITAL SYSTEM, INC.
Location Address29804 LAKESHORE BLVDWillowick, OH 44095-4611
Mailing AddressPo Box 714328Columbus, OH 43271-4328 · (800) 354-1985 · Fax (440) 350-4938
Phone(440) 354-1899
Fax(440) 354-1089
Organization SubpartNo
Authorized OfficialRobert TraczChief Financial Officer · (440) 354-1642
Enumeration DateJanuary 7, 2009
✔ NPI 1639315062 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
29804 LAKESHORE BLVD, Willowick, OH 44095
Open in Google Maps ↗

Other Names 1

Doing Business AsPrimehealth Sports Medicine

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)

Primehealth Sports Medicine 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 Sports Medicine, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 144 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
Angela Brinkman, DO
Family Practice
NPI 1982797874
29804 LAKESHORE BLVD. LHPG WILLOWICK PRIMARY CARE
Willowick, OH 44095
(440) 833-2095
✔ PECOS✔ Accepts MedicareSame address
Britt Conroy, MD, PHD
Family Practice
NPI 1174813638
29804 LAKESHORE BLVD
Willowick, OH 44095
(440) 833-2095
✔ PECOS✔ Accepts MedicareSame address
Cherrica Davis, M.D.
Internal Medicine
NPI 1487677233
29804 LAKESHORE BOULEVARD
Willowick, OH 44095
(440) 833-2095
✔ PECOS✔ Accepts MedicareSame address
Gwen Haas, MD
Family Practice
NPI 1710092267
29804 LAKESHORE BLVD
Willowick, OH 44095
(440) 833-2095
✔ PECOS✔ Accepts MedicareSame address
Brian Juriga, DO
Family Practice
NPI 1245290204
29804 LAKESHORE BLVD.
Willowick, OH 44095
(440) 833-2010
✔ PECOS✔ Accepts MedicareSame address
Kelly Manger, M.D.
Family Practice
NPI 1528593894
29804 LAKE SHORE BLVD
Willowick, OH 44095
(440) 833-2095
✔ PECOS✔ Accepts MedicareSame address
Jessica Madden, M.D.
Pediatric Medicine
NPI 1679511976
31731 LAKE SHORE BLVD
Willowick, OH 44095
(216) 313-2016
✔ PECOS1.0 mi
Rebecca Crockett, DO
Obstetrics/Gynecology
NPI 1376702241
5105 SOM CENTER ROAD SUITE 201
Willoughby, OH 44094
(440) 602-6710
✔ PECOS✔ Accepts Medicare2.1 mi
Gary Kammer, M.D.
Rheumatology
NPI 1083685952
5105 SOM CENTER RD # 105
Willoughby, OH 44094
(440) 953-8700
✔ PECOS2.1 mi
Elise Leone, CNP
Nurse Practitioner
NPI 1447684592
5105 SOM CENTER ROAD STE 202
Willoughby, OH 44094
(440) 953-5760
✔ PECOS2.1 mi
Patrick Mcintyre, MD
Pain Management
NPI 1831142140
5105 SOM CENTER ROAD SUITE 202
Willoughby, OH 44094
(440) 953-5760
✔ PECOS✔ Accepts Medicare2.1 mi
Tam Mclean
Family Practice
NPI 1114260122
5105 SOM CENTER RD #106
Willoughby, OH 44094
(440) 953-5740
✔ PECOS✔ Accepts Medicare2.1 mi
Henry Vucetic, MD
Anesthesiology
NPI 1104015213
5105 SOM CENTER ROAD SUITE 202
Willoughby, OH 44094
(440) 953-5760
✔ PECOS2.1 mi
Brian Burtch, M.D.
Endocrinology
NPI 1184745143
5105 SOM CENTER RD STE 106
Willoughby, OH 44094
(440) 266-5000
✔ PECOS✔ Accepts Medicare2.2 mi
Iola Pustelnick, C.N.M.
Certified Nurse Midwife (CNM)
NPI 1275566556
36001 EUCLID AVE STE C7
Willoughby, OH 44094
(440) 602-6710
✔ PECOS✔ Accepts Medicare2.4 mi
Patrick Convery, MD
Orthopedic Surgery
NPI 1437230307
36060 EUCLID AVE STE 203
Willoughby, OH 44094
(440) 602-6670
✔ PECOS✔ Accepts Medicare2.5 mi
William Petraiuolo, MD
General Surgery
NPI 1144336470
36060 EUCLID AVE SUITE 204
Willoughby, OH 44094
(440) 602-6553
✔ PECOS2.5 mi
Laura Bailey, MD
Internal Medicine
NPI 1770699019
36100 EUCLID AVE #240
Willoughby, OH 44094
(440) 953-6294
✔ PECOS✔ Accepts Medicare2.5 mi
Christopher Daugherty, M.D.
Ophthalmology
NPI 1770926818
36100 EUCLID AVE STE 450
Willoughby, OH 44094
(440) 946-9555
✔ PECOS✔ Accepts Medicare2.5 mi
Timothy Doyle, MD
Cardiovascular Disease (Cardiology)
NPI 1861451403
36100 EUCLID AVE SUITE 120
Willoughby, OH 44094
(440) 951-8360
✔ PECOS2.5 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 1639315062. It was assigned to this organization in the NPPES registry on January 7, 2009. The provider is doing business as Primehealth Sports Medicine.

Where is Lake Hospital System, Inc. located?

Lake Hospital System, Inc. is located at 29804 Lakeshore Blvd, Willowick, OH 44095. The listed phone number is (440) 354-1899.

What is Lake Hospital System, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

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, 6 practice at this address and 144 within 10 miles. 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 Hospital System, Inc. was last updated on January 7, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.