COUNTY OF LAKE — NPI 1578861761 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in LOWER LAKE, CA)

CMS-1500 Box 24J / 33a • NPI

1578861761

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR0405X (CMS D5)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

9345 WINCHESTER ST, LOWER LAKE, CA, 95457-5000

✓ 9-Digit EDI 837 ZIP+4 (95457-5000)

Practice Phone & Referral Fax

(707) 994-6494

Fax: (707) 994-7092

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1578861761 (COUNTY OF LAKE) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1578861761` (NPI-2 Organization / Facility)
Provider / Legal Name	COUNTY OF LAKE
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR0405X` (Clinic/Center, Rehabilitation, Substance Use Disorder)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	9345 WINCHESTER ST, LOWER LAKE, CA, 95457-5000
Practice Telephone / Fax	Tel: (707) 994-6494 \| Fax: (707) 994-7092
Administrative Mailing Address	991 PARALLEL DR., LAKEPORT, CA, 95453-5717
Enumeration & Last Sync	Enumerated: 2011-03-11 \| CMS Record Updated: 2024-08-26
Authorized Official	KRISTY KELLY (DEPARTMENT HEAD)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

9345 WINCHESTER ST, LOWER LAKE, CA, 95457-5000

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Plain-English Taxonomy & CMS Crosswalk (261QR0405X)

What Does Taxonomy Code 261QR0405X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0405X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code D5 (Opioid Treatment Program)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (COUNTY OF LAKE)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QR0405X` — Clinic/Center, Rehabilitation, Substance Use Disorder Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: CA \| License: `170002BN` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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COUNTY OF LAKE (NPI #1578861761)