Lake Superior State University
NPI 1467454199 · Family Medicine Physician · Sault Sainte Marie, MI
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Lake Superior State University is a Family Medicine Physician organization in Sault Sainte Marie, MI (NPI 1467454199).
Provider details
- NPI number
- 1467454199
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kenneth Peress, Vice President Student Affairs(906) 635-2634
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Nurse Practitioner363L00000X
Physician Assistants & Advanced Practice Nursing Providers
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 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
Mailing address
Registry dates
- Enumerated
- 2005-08-12
- Last updated
- 2008-12-12
Frequently asked questions
- What is Lake Superior State University's NPI number?
- Lake Superior State University's National Provider Identifier (NPI) is 1467454199, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lake Superior State University?
- Lake Superior State University is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Lake Superior State University located?
- Lake Superior State University's practice location on file with NPPES is 650 W Easterday Ave, Sault Sainte Marie, MI 49783-1656.
- What is Lake Superior State University's phone number?
- The practice phone number listed in the NPPES registry for Lake Superior State University is (906) 635-2110.
- Does Lake Superior State University accept Medicare?
- Lake Superior State University 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 Superior State University?
- The authorized official listed on Lake Superior State University's NPPES record is Kenneth Peress, Vice President Student Affairs. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lake Superior State University's NPI active?
- Yes — Lake Superior State University's NPI (1467454199) is active in the NPPES registry as of the last update on 2008-12-12.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.