Lake Street Family Medicine, LLC
NPI 1639204613 · Family Medicine Physician · Addison, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Lake Street Family Medicine, LLC is a Family Medicine Physician organization in Addison, IL (NPI 1639204613).
Provider details
- NPI number
- 1639204613
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Brian Koecher, Physician(630) 516-0434
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 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
- 2007-02-22
- Last updated
- 2012-12-11
Frequently asked questions
- What is Lake Street Family Medicine, LLC's NPI number?
- Lake Street Family Medicine, LLC's National Provider Identifier (NPI) is 1639204613, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lake Street Family Medicine, LLC?
- Lake Street Family Medicine, LLC is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Lake Street Family Medicine, LLC located?
- Lake Street Family Medicine, LLC's practice location on file with NPPES is 220 E Lake St, Addison, IL 60101-2887.
- What is Lake Street Family Medicine, LLC's phone number?
- The practice phone number listed in the NPPES registry for Lake Street Family Medicine, LLC is (630) 516-0434.
- Does Lake Street Family Medicine, LLC accept Medicare?
- Lake Street Family Medicine, 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 Street Family Medicine, LLC?
- The authorized official listed on Lake Street Family Medicine, LLC's NPPES record is Brian Koecher, Physician. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lake Street Family Medicine, LLC's NPI active?
- Yes — Lake Street Family Medicine, LLC's NPI (1639204613) is active in the NPPES registry as of the last update on 2012-12-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.