OrganizationActive
Lake Hospital System, Inc.
NPI 1124255278 · Vascular Surgery Physician · Willoughby, OH
Provider details
- NPI number
- 1124255278
- Entity type
- Organization
- Primary specialty
- Vascular Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Richard Cicero, Sr. Vp, Business Development(440) 354-1739
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Surgery Physician208600000X
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
36001 Euclid Ave
B-3
Willoughby, OH 44094-4643
Phone: (440) 953-1898
Fax: (440) 953-9296
Street-level locationGet directions
Mailing address
Po Box 714328
Columbus, OH 43271-4328
Other names (DBA / former)
- Doing business as
- Lake Health Physician Group Vascular Access Surgery
Registry dates
- Enumerated
- 2009-06-16
- Last updated
- 2011-04-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.