Lake Girl, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

138512 Issued in MO

Legal business name

LAKE GIRL, INC

Doing business as

Hometown Family Medicine

Practice address

4581 Gravois Rd
House Springs, MO 63051-1374

Phone

(636) 671-9980

Fax

(636) 671-9981

NPI assigned

Aug 14, 2014

Last updated

Dec 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Renee L Willer, APRNNPI 1477530814

Title

Owner

Phone

(314) 322-7017

Specialties & licenses 1

Addresses

Other names 1

• Hometown Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Renee L Willer, APRN

  • Family Nurse Practitioner
  • House Springs, MO
  • NPI 1477530814
  Medicare reassignment Care Compare group NPD Authorized official
• Linda Rene Winterberger, DO

  • Family Medicine Physician
  • House Springs, MO
  • NPI 1295706513
  Medicare reassignment Care Compare group NPD
• Zachary Voss

  • Family Nurse Practitioner
  • House Springs, MO
  • NPI 1346115433
  Medicare reassignment Care Compare group
• Charles Martin Sackmann, MD

  • Family Medicine Physician
  • Ritzville, WA
  • NPI 1396759635
  NPD (past)

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1255730446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4581 GRAVOIS RD",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630511374",
            "telephone_number": "636-671-9980",
            "fax_number": "636-671-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4581 GRAVOIS RD",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630511374",
            "telephone_number": "636-671-9980",
            "fax_number": "636-671-9981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE GIRL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-14",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "WILLER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-322-7017",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MO",
            "license": "138512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hometown Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Kaestner
• Kenneth Ross DO LLC
• Josie Ann Kleinheider
• Madison Maria Kraemer, MS, CF-SLP
• Susana Kuczka
• Lin Kris Pharmacy Inc (House Springs Pharmacy)
• Lin-Kris Pharmacy Inc (House Springs Pharmacy)
• Ashley Lindsey
• Susan Luedde
• Molly R Magary, LPC

• Primary Care Clinic/Center in House Springs, MO
• Providers in House Springs, MO by specialty
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.