LAKE FAMILY MEDICAL PRACTICE PC
NPI 1639923675
Family Medicine in Lake Ronkonkoma, NY
About Lake Family Medical Practice Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE FAMILY MEDICAL PRACTICE PC (NPI 1639923675) is a healthcare organization registered as a family medicine in Lake Ronkonkoma, New York and active in the NPI registry since April 2024. The organization lists Robert A Tufano, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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 Family Medical Practice Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lake Family Medical Practice PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Family Medical Practice PC's NPI number?
The NPI number for Lake Family Medical Practice PC is 1639923675. It was assigned to this organization in the NPPES registry on April 16, 2024.
Where is Lake Family Medical Practice PC located?
Lake Family Medical Practice PC is located at 201 Portion Rd Ste A, Lake Ronkonkoma, NY 11779. The listed phone number is (631) 981-1333.
What is Lake Family Medical Practice PC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lake Family Medical Practice PC enrolled in Medicare?
Yes. Lake Family Medical Practice PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lake Family Medical Practice PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Lake Family Medical Practice PC. 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. 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 Family Medical Practice PC was last updated on November 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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 Family Medical Practice Pc · NPI 1639923675
Family Medicine organization in Lake Ronkonkoma, New York. Organization record, active in the CMS NPPES registry since April 16, 2024.
## Identity
- **NPI:** 1639923675 (Entity type: Organization)
- **Enumerated:** April 16, 2024
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Robert Tufano, CEO
## Practice location
- **Address:** 201 PORTION RD STE A, Lake Ronkonkoma, NY 11779-4172
- **Phone:** (631) 981-1333 · **Fax:** (631) 981-2326
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 13, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1639923675) · Data from the CMS NPPES public registry.