LAKE ENDOSCOPY CENTER, LLC – Ambulatory Surgical Clinic/Center, NPI 1750823886
Ambulatory Surgical Clinic/Center
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for LAKE ENDOSCOPY CENTER, LLC
17355 SE 109TH TERRACE RD
SUMMERFIELD, FL 34491
Phone: (352) 245-0846
Fax: (352) 245-7768
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-03-14
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1051 days ago).
Enrollment records
1
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20170314000127 | O | Ambulatory Surgical Center | FL | 2023-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | 812 | 806 | $0 |
| 45380 | Biopsy of large bowel using a flexible endoscope | 693 | 689 | $0 |
| 43239 | Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope | 667 | 640 | $0 |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 267 | 264 | $0 |
| 43248 | Insertion of guide wire with dilation of esophagus using a flexible endoscope | 262 | 253 | $0 |
Insurance plans in this area (ZIP 34491)
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