NPIMap

Organization Active NPI

Lakewood Health System

Doing business as Lakewood Clinic Eagle Bend

  • Rural Health Clinic/Center
  • Eagle Bend, MN
National Provider Identifier
1093706160
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAKEWOOD HEALTH SYSTEM
Doing business as
Lakewood Clinic Eagle Bend
Practice address
815 Hwy 71 South
Eagle Bend, MN 56446
Phone
(218) 738-2804
Fax
(218) 898-7593
NPI assigned
Oct 28, 2005
Last updated
Jun 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph T Reycraft
Title
Cfo
Phone
(218) 894-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MN Primary

Addresses

Primary practice location

815 Hwy 71 South
Eagle Bend, MN 56446

Mailing address

49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515

Other names 1

  • Lakewood Clinic Eagle Bend Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021018000015 MN Part A Provider - Rural Health Clinic 1052229671 Practice locations: Eagle Bend, MN
O20031104000411 MN Part B Supplier - Clinic/Group Practice 1052229671 Receives reassigned benefits from 148 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sartell, MN; Staples, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093706160. Details of each certification follow.

Rural health clinic certification: CCN 243421

Legal name
LAKEWOOD HEALTH SYSTEM
Doing business as
LAKEWOOD CLINIC-BROWERVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 11, 2003
Last certification
Jul 28, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 31, 1996 in MN
Enrollment address
815 Hwy 71 S
Eagle Bend, MN 56446
Related CCNs
241329

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0674215Lakewood Health System-Eagle Bend Clinic815 Hwy 71 South, Eagle Bend, MN 56446ComplianceOct 17, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 35

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melissa Beth Lindow Individual Corporate OfficerChief Operating Officer Aug 27, 2023
Operational/Managerial ControlChief Operating Officer Aug 27, 2023
Billy Joe Haehnel Individual Corporate Director Nov 1, 2015
Joseph Thomas Reycraft Individual Corporate OfficerCfo Aug 28, 2022
Operational/Managerial ControlCfo Aug 28, 2022
Lakewood Health System Organization, Staples, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 1997 100%
Curtis Eugene McIlravy Individual Corporate OfficerSystem Board Chair Jul 1, 2021
Corporate Director Jul 1, 2014
Ryan David Kray Individual Corporate DirectorBoard Member Oct 1, 2021
Robert Michael Mueller Individual Corporate DirectorDistrict Vice Chair Jun 25, 2015
Sara Jane Grove Individual Corporate Director Apr 24, 2014
Craig Thomas Wolhowe Individual Corporate OfficerVP of Clinics & Medical Providers Jun 11, 1997
Operational/Managerial ControlVP of Clinics & Medical Providers Jun 11, 1997
Alicia Kay Bauman Individual Corporate OfficerChief Talent Officer Oct 9, 2022
Operational/Managerial ControlChief Talent Officer Oct 9, 2022
Mary Martha Theurer Individual Corporate OfficerDistrict Chair/System Secretary Jan 1, 2010
Elizabeth Ann Pottratz Individual Corporate DirectorBoard Member Jan 1, 2023
Lisa Marie Bjerga Individual Corporate OfficerCeo/President Mar 7, 2016
Operational/Managerial ControlCeo/President Mar 7, 2016
Kaitlyn Rose Schoeck Individual Corporate DirectorBoard Member Aug 7, 2017
Lana Ellen Hansen Individual Corporate OfficerDistrict Secretary Jan 1, 2008
Ronald Alvin Storbakken Individual Corporate Director Jan 1, 2000
Franz Harry Achermann Individual Corporate DirectorBoard Member Jan 1, 2025
Kathleen Marie Dobson Individual Operational/Managerial ControlVP of Senior Services Dec 1, 2014
James Alan Roeder Individual Operational/Managerial ControlVP of Information Technology Jan 1, 2018
Mary Ann Fitcher Individual Corporate DirectorBoard Member Jan 1, 2025
Brad Richard Anderson Individual Corporate OfficerChief Development Officer Aug 13, 2014
Operational/Managerial ControlChief Development Officer Aug 13, 2014
Amy Jo Brichacek Individual Corporate DirectorBoard Member Jan 1, 2021
Emil Paul Wicht Individual Corporate Director Oct 18, 2002
Melissa Sue Daniels Individual W-2 Managing EmployeeExecutive Assistant to the Cfo Sep 15, 2016
Michael Lee Austin Individual Operational/Managerial ControlVP of Clinic Services Dec 30, 2024
Norman Harold Krause Individual Corporate DirectorBoard Member Jul 1, 2018
Daniel John Douts Individual Corporate DirectorBoard Member May 1, 2024
Susan Kay Peet Individual Corporate DirectorDistrict Treasurer Jan 1, 2021
Wade Thomas Swenson Individual Corporate DirectorBoard Member Jan 1, 2023
Lindsay Rae Leveille Individual Corporate DirectorBoard Member Jul 1, 2023
Christine Sara Albrecht Individual Corporate Director Jun 30, 2009
Operational/Managerial ControlCmo Jun 1, 2020
Sarah Ann Jennissen Individual Corporate DirectorBoard Member Jul 1, 2024
Beverly Jean Hoemberg Individual Corporate Director Jan 1, 2011
Jef Richard Cichos Individual Corporate OfficerSystem Vice Chair Jul 1, 2021
Corporate Director Jul 1, 2016
Sarah Jane Baumgartner Individual Operational/Managerial ControlVP of Nursing Jul 1, 2024

Owners & managing parties with NPI records 19

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 19

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakewood ClinicStaples, MN, CCN 243422 Rural health clinic 5% Or Greater Direct Ownership Interest
General Partnership Interest		 Apr 1, 1997
Apr 1, 1997
Lakewood Clinic-PillagerPillager, MN, CCN 243436 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Mar 1, 1998
Mar 1, 1998

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Lakewood Health System

    dba Lakewood Clinic Pillager

    • Rural Health Clinic/Center
    • Pillager, MN
    • NPI 1811988983

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Lakewood Health System

    dba Lakewood Clinic Staples

    • Rural Health Clinic/Center
    • Staples, MN
    • NPI 1841280823

    5% Or Greater Direct Ownership Interest, General Partnership Interest

    CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1093706160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-898-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 HWY 71 SOUTH",
            "city": "EAGLE BEND",
            "state": "MN",
            "postal_code": "56446",
            "telephone_number": "218-738-2804",
            "fax_number": "218-898-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "REYCRAFT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-894-8194"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Clinic Eagle Bend",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle Bend, MN

Sources for this page

Verify at the official NPI Registry.