NPIMap

Organization Active NPI

Lake Regional Health System

Doing business as Lake Regional Obstetrics & Gynecology

  • Rural Health Clinic/Center
  • Osage Beach, MO
National Provider Identifier
1316616212
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
Lake Regional Obstetrics & Gynecology
Practice address
54 Hospital Dr Ste 201
Osage Beach, MO 65065-3050
Phone
(573) 302-2764
Fax
(573) 302-2767
NPI assigned
Sep 13, 2021
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Kevin McRoberts
Title
Ceo
Phone
(573) 348-8756

Specialties & licenses 1

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

Addresses

Primary practice location

54 Hospital Dr Ste 201
Osage Beach, MO 65065-3050

Mailing address

PO Box 801661
Kansas City, MO 64180-1661
Phone (573) 348-8000

Other names 1

  • Lake Regional Obstetrics & Gynecology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210924000114 MO Part A Provider - Rural Health Clinic 9133026776 Practice locations: Osage Beach, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316616212. Details of each certification follow.

Rural health clinic certification: CCN 268786

Legal name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
LAKE REGIONAL OBSTETRICS & GYNECOLOGY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 19, 2022
Last certification
Feb 4, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
54 Hospital Dr
Ste 201
Osage Beach, MO 65065-3050
Related CCNs
260186

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Lake of the Ozarks GH20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Dennis Michaelree Individual Corporate DirectorSecretary Sep 1, 2021
John C Patton Individual Corporate DirectorBoard Member Jun 3, 2022
Karen K. Faiferlick Individual Corporate OfficerPresident Jun 3, 2022
Corporate DirectorBoard Member Sep 1, 2021
Gregory D Anderson Individual Corporate DirectorBoard Member Sep 1, 2021
Kevin G McRoberts Individual Corporate OfficerCeo Sep 1, 2021
Charles McElyea Individual Corporate DirectorAssistant Secretary Sep 1, 2021
Mark Rector Individual Corporate DirectorBoard Member Sep 1, 2021
Warren T Cooper Individual Corporate DirectorBoard Member-Chief of Staff Jun 6, 2024
Alan W Mead Individual Corporate DirectorBoard Member Sep 1, 2021
Paula Littleton Individual Corporate OfficerCfo Jul 22, 2024
Jason Hulett Individual Corporate DirectorBoard Member Sep 1, 2021
Jessica Hasty Individual W-2 Managing EmployeeManaged Care Coordinator Sep 1, 2021
Corey M Tenbensel Individual Corporate DirectorBoard Member Sep 1, 2021
Larry Shields Individual Corporate DirectorBoard Member Sep 1, 2021
John Caine Individual Corporate DirectorBoard Member Sep 1, 2021
Kevin G Byrne Individual Corporate DirectorBoard Member Sep 1, 2021
Kristen L Prenger Individual Operational/Managerial ControlDirector of Managed Care Jan 1, 2024
Wayne Compton Individual Corporate DirectorTreasurer Sep 1, 2021
James D. Judas Individual Corporate DirectorBoard Member Sep 1, 2021

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lake Regional Health SystemOsage Beach, MO, CCN 265429 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Nov 23, 2006
Jan 3, 2025
Feb 23, 2006

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1316616212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801661",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801661",
            "telephone_number": "573-348-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 HOSPITAL DR STE 201",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-302-2764",
            "fax_number": "573-302-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-13",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "MCROBERTS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-348-8756"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Regional Obstetrics & Gynecology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Regional Obstetrics & Gynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.