Lake Country Endoscopy Center, LLC
NPI 1184897472 · Ambulatory Surgical Clinic/Center · Oconomowoc, WI
Enrolled with Medicare as Part B Supplier - Ambulatory Surgical Center · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Lake Country Endoscopy Center, LLC is a Ambulatory Surgical Clinic/Center organization in Oconomowoc, WI (NPI 1184897472).
Provider details
- NPI number
- 1184897472
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Bao Xiong Thao, Authorized Official(414) 908-6506
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
18 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
784 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. 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.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Removal of Polyps Or Growths of Large Bowel Using an Endoscope With Mechanical Snare45385 | 231 | $585 |
| Biopsy of Large Bowel Using a Flexible Endoscope45380 | 168 | $461 |
| Biopsy of Esophagus, Stomach, And/Or Upper Small Bowel Using a Flexible Endoscope43239 | 151 | $312 |
| Colorectal Cancer Screening; Colonoscopy on Individual at High RiskG0105 | 102 | $451 |
| Colorectal Cancer Screening; Colonoscopy on Individual Not Meeting Criteria for High RiskG0121 | 43 | $456 |
Practice location
Mailing address
Registry dates
- Enumerated
- 2008-04-08
- Last updated
- 2025-01-08
- Certified
- 2025-01-08
Frequently asked questions
- What is Lake Country Endoscopy Center, LLC's NPI number?
- Lake Country Endoscopy Center, LLC's National Provider Identifier (NPI) is 1184897472, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lake Country Endoscopy Center, LLC?
- Lake Country Endoscopy Center, LLC is classified in the NPPES registry as Ambulatory Surgical Clinic/Center (Ambulatory Health Care Facilities).
- Where is Lake Country Endoscopy Center, LLC located?
- Lake Country Endoscopy Center, LLC's practice location on file with NPPES is 1185 Corporate Center Dr, Oconomowoc, WI 53066-4845.
- What is Lake Country Endoscopy Center, LLC's phone number?
- The practice phone number listed in the NPPES registry for Lake Country Endoscopy Center, LLC is (414) 454-0600.
- Does Lake Country Endoscopy Center, LLC accept Medicare?
- Lake Country Endoscopy Center, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Lake Country Endoscopy Center, LLC?
- The authorized official listed on Lake Country Endoscopy Center, LLC's NPPES record is Bao Xiong Thao, Authorized Official. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lake Country Endoscopy Center, LLC's NPI active?
- Yes — Lake Country Endoscopy Center, LLC's NPI (1184897472) is active in the NPPES registry as of the last update on 2025-01-08.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.