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LAKE SHORE OB GYN OF DECATUR S C
NPI 1700925583
Specialist in Decatur, IL

Active since February 06, 2007
741 W PERSHING RD, DECATUR, IL 62526(217) 429-4119(217) 429-0108 Get Directions Write a Review

NPPES record last updated: May 13, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Lake Shore Ob Gyn Of Decatur S C NPPES

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

LAKE SHORE OB GYN OF DECATUR S C (NPI 1700925583) is a healthcare organization registered as a specialist in Decatur, Illinois and active in the NPI registry since February 2007. The organization lists Adel Samy Hanna, Owner, as its authorized official.

NPPES Registry Identity

NPI1700925583
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameLAKE SHORE OB GYN OF DECATUR S C
Location Address741 W PERSHING RDDecatur, IL 62526-1634
Mailing Address1770 E Lake Shore Dr, Suite 303Decatur, IL 62521-3832 · (217) 429-4119 · Fax (217) 429-0108
Phone(217) 429-4119
Fax(217) 429-0108
Organization SubpartNo
Authorized OfficialAdel Samy HannaOwner · (217) 429-4119
Enumeration DateFebruary 6, 2007
Last NPPES UpdateMay 13, 2025
NPPES CertifiedMay 13, 2025
✔ NPI 1700925583 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
741 W PERSHING RD, Decatur, IL 62526
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Other Identifiers 3

Other634112Health Link
Other05832038IL · Blue Cross Blue Shield
Medicaid036110172IL

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 Shore Ob Gyn Of Decatur S C 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 Shore Ob Gyn Of Decatur S C, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Nada Lygrisse, D.O
Obstetrics/Gynecology
NPI 1871919134
741 W PERSHING RD
Decatur, IL 62526
(217) 429-4119
✔ PECOS✔ Accepts MedicareSame address
Adel Raheb, M.D.
Obstetrics/Gynecology
NPI 1265418982
101 W UNIVERSITY AVE STE 303
Champaign, IL 61820
(217) 366-1255
✔ PECOS✔ Accepts Medicare42 mi

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 Shore Ob Gyn Of Decatur S C's NPI number?

The NPI number for Lake Shore Ob Gyn Of Decatur S C is 1700925583. It was assigned to this organization in the NPPES registry on February 6, 2007.

Where is Lake Shore Ob Gyn Of Decatur S C located?

Lake Shore Ob Gyn Of Decatur S C is located at 741 W Pershing Rd, Decatur, IL 62526. The listed phone number is (217) 429-4119.

What is Lake Shore Ob Gyn Of Decatur S C's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Lake Shore Ob Gyn Of Decatur S C enrolled in Medicare?

Yes. Lake Shore Ob Gyn Of Decatur S C is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake Shore Ob Gyn Of Decatur S C?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Obstetrics/Gynecology, reassign their Medicare billing to Lake Shore Ob Gyn Of Decatur S C. 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.

When was this NPI record last updated?

The NPPES record for Lake Shore Ob Gyn Of Decatur S C was last updated on May 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.