NPIMap

Organization Active NPI

St Luke's Lakeside Hospital, LLC

Doing business as St Luke's Lakeside Hospital

  • Special Hospital
  • The Woodlands, TX
National Provider Identifier
1184868879
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Special HospitalTaxonomy code 284300000X
Legal business name
ST LUKE'S LAKESIDE HOSPITAL, LLC
Doing business as
St Luke's Lakeside Hospital
Practice address
17400 St. Luke's Way
The Woodlands, TX 77384
Phone
(936) 266-4055
Fax
(936) 266-4051
NPI assigned
Apr 24, 2009
Last updated
Jan 6, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LUKE'S HEALTH SYSTEM,As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Authorized official

Name
Mrs. Mary Sue Lipham
Title
Chief Financial Officer
Phone
(936) 266-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Special Hospital 284300000X NU Primary

Addresses

Primary practice location

17400 St. Luke's Way
The Woodlands, TX 77384

Mailing address

17400 St. Luke's Way
The Woodlands, TX 77384
Phone (936) 266-4055

Other identifiers 1

IdentifierTypeStateIssuer
160630301MedicaidTX

Other names 1

  • St Luke's Lakeside Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090715000303 TX Part A Provider - Hospital 3173675527 Practice locations: The Woodlands, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184868879. Details of each certification follow.

Hospital certification: CCN 670059

Legal name
ST LUKE'S LAKESIDE HOSPITAL, LLC
Doing business as
ST LUKE'S LAKESIDE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 10, 2009
Last certification
Aug 8, 2024
Beds
30
Ownership / control type
Other
Organization structure
LLCProprietary
Incorporated
Apr 23, 2009 in TX
Enrollment address
17400 St Lukes Way
The Woodlands, TX 77384-8036
Main/Primary Hospital Location
Hospital subgroups
General, Specialty hospital

Care Compare: Hospital

Medicare Care Compare
Listed as
CHI St Lukes Lakeside HospitalCCN 670059 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
CHI St Luke's Health Baylor St Luke's Medical Center

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
St. Lukes Health System Corporation Organization, Houston, TX Corporation, Non-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2013 51%
Commonspirit Health Organization, Chicago, IL Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2023 51%
Christopher H Lavergne Individual General Partnership Interest Jul 31, 2007
Corporate Director Jul 31, 2007
Peter Shedden Individual General Partnership Interest Dec 31, 2008
Corporate Director Jun 12, 2013
James Parisi Individual Corporate OfficerCeo Jan 29, 2018
Corporate DirectorCeo Jan 29, 2018
W-2 Managing EmployeeCeo Jan 29, 2018
Clay J Fisher Individual General Partnership Interest Jul 31, 2007
Kedarnath a Vaidya Individual General Partnership Interest Dec 11, 2015
St Lukes Community Development Corporation Organization, The Woodlands, TX Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 23, 2009 51%
David C. Strickler Individual Corporate Officer Oct 30, 2017
W-2 Managing EmployeeCfo Oct 30, 2017

Owners & managing parties with NPI records 4

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

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 164

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 164

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1184868879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17400 ST. LUKE'S WAY",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "936-266-4055",
            "fax_number": "936-266-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17400 ST. LUKE'S WAY",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "936-266-4055",
            "fax_number": "936-266-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S LAKESIDE HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKE'S HEALTH SYSTEM,",
        "enumeration_date": "2009-04-24",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "LIPHAM",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "936-266-2030",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160630301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Luke's Lakeside Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Woodlands, TX

Sources for this page

Verify at the official NPI Registry.