NPIMap

Organization Active NPI

Lake Region Healthcare Corporation

  • General Acute Care Hospital
  • Fergus Falls, MN
National Provider Identifier
1093713372
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
327293 Issued in MN
Legal business name
LAKE REGION HEALTHCARE CORPORATION
Practice address
712 S Cascade St
Fergus Falls, MN 56537-2913
Phone
(218) 736-8000
Fax
(218) 736-8775
NPI assigned
Jul 12, 2005
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Kent Mattson
Title
Ceo
Phone
(218) 736-8090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 327293 MN Primary

Addresses

Primary practice location

712 S Cascade St
Fergus Falls, MN 56537-2913

Mailing address

712 S Cascade St
Fergus Falls, MN 56537-2913
Phone (218) 736-8000

Other identifiers 7

IdentifierTypeStateIssuer
510847100MedicaidMN
1637HLAOtherMNBLUE CROSS
510847101MedicaidMN
1637ELAOtherMNBLUE CROSS
316714300MedicaidMN
510847167MedicaidMN
60685LAOtherMNBLUE CROSS

National Provider Directory

National Provider Directory

Locations

619 S Cascade St
Fergus Falls, MN 56537
Phone (218) 736-8451

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/

Practitioners & affiliated clinicians

Practitioners 258

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 258

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1093713372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 S CASCADE ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372913",
            "telephone_number": "218-736-8000",
            "fax_number": "218-736-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 S CASCADE ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372913",
            "telephone_number": "218-736-8000",
            "fax_number": "218-736-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGION HEALTHCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-736-8090"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MN",
            "license": "327293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510847100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1637HLA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510847101",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1637ELA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316714300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510847167",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "60685LA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.