NPIMap

Organization Active NPI

Lake Health District

Doing business as Lake District Hospital

  • Critical Access Hospital
  • Lakeview, OR
National Provider Identifier
1376698522
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
140896 Issued in OR
Legal business name
LAKE HEALTH DISTRICT
Doing business as
Lake District Hospital
Practice address
700 S J St
Lakeview, OR 97630-1623
Phone
(541) 947-2114
Fax
(541) 947-2433
NPI assigned
Jan 25, 2007
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Landon Dybdal
Title
Ceo
Phone
(541) 947-2114

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 140896 OR
Critical Access Hospital 282NC0060X 140896 OR Primary
Skilled Nursing Facility 314000000X 1836773096 OR

Addresses

Primary practice location

700 S J St
Lakeview, OR 97630-1623

Mailing address

700 S J St
Lakeview, OR 97630-1623
Phone (541) 947-2114

Other practice location 1

700 S J St
Lakeview, OR 97630-1623
Phone (541) 947-2114

Other identifiers 3

IdentifierTypeStateIssuer
802595OtherORMEDICAIDORE.HEALTHL.T.C.
106146MedicaidOR
107532OtherORMEDICAID OREGON HEALTH

Other names 1

  • Lake District Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, UT, NY, NM, CO, CA9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20040419000549 OR Part B Supplier - Clinic/Group Practice 4284629221 Receives reassigned benefits from 73 practitioners
1 other NPI on this enrollment
Practice locations: Lakeview, OR
O20061104000374 OR Part A Provider - Critical Access Hospital 4284629221 Receives reassigned benefits from 59 practitioners
Practice locations: Lakeview, OR
O20071003000675 OR Part A Provider - Critical Access Hospital 4284629221 Practice locations: Lakeview, OR
O20250623003200 UT Part B Supplier - Hospital Department(S) 4284629221 Receives reassigned benefits from 1 practitioner
Practice locations: Alpine, UT
O20250724000524 NY Part B Supplier - Hospital Department(S) 4284629221 Receives reassigned benefits from 1 practitioner
Practice locations: Manhasset, NY
O20251113003517 NM Part B Supplier - Hospital Department(S) 4284629221 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20251129000190 CO Part B Supplier - Clinic/Group Practice 4284629221 Receives reassigned benefits from 2 practitioners
Practice locations: Carbondale, CO; Fort Collins, CO
O20251209001239 CO Part B Supplier - Hospital Department(S) 4284629221 Receives reassigned benefits from 1 practitioner
Practice locations: Carbondale, CO
O20260109001791 CA Part B Supplier - Hospital Department(S) 4284629221 Receives reassigned benefits from 3 practitioners
Practice locations: Long Beach, CA; La Jolla, CA; Sacramento, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1376698522. Details of each certification follow.

Hospital certification: CCN 381309

Legal name
LAKE HEALTH DISTRICT
Doing business as
LAKE DISTRICT HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 5, 2001
Last certification
Aug 14, 2025
Beds
24 (21 certified)
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Jul 18, 1967 in OR
Enrollment address
700 S J St
Lakeview, OR 97630-1623
Other Hospital Practice Location

Hospital certification: CCN 38Z309

Legal name
LAKE HEALTH DISTRICT
Organization structure
OtherNon-profit
Incorporated
Jul 18, 1967 in OR
Enrollment address
700 S J St
Lakeview, OR 97630-1623
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Lake District HospitalCCN 381309 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
38D2008921Lake District Hospital EMS700 South J St, Lakeview, OR 97630Certificate of waiverJun 3, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1250 S 9th St
Lakeview, OR 97630
Phone (541) 947-2114

215 N G St
Lakeview, OR 97630
Phone (541) 653-0682

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Jennifer Antle Individual Operational/Managerial ControlManager Aug 1, 2024
W-2 Managing Employee Aug 1, 2024
Landon Dybdal Individual Corporate OfficerCeo Jan 1, 2024 100%
W-2 Managing EmployeeAd; Apr 1, 2024 100%
Jane H O'Keeffe Individual Corporate DirectorBoard Member Jun 10, 2016
Jerald Steward Individual Corporate DirectorBoard Member Jun 27, 2016
Don Liddycoat Individual Corporate DirectorBoard Member Jun 27, 2016
Cheryl J Cornwell Individual Operational/Managerial Control Sep 16, 2013

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 Health DistrictLakeview, OR, CCN 388517 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 87

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 87

Affiliated clinicians 82

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

View all 82

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1376698522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S J ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301623",
            "telephone_number": "541-947-2114",
            "fax_number": "541-947-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S J ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301623",
            "telephone_number": "541-947-2114",
            "fax_number": "541-947-2433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 S J St",
            "address_purpose": "LOCATION",
            "city": "Lakeview",
            "state": "OR",
            "postal_code": "976301623",
            "country_code": "US",
            "telephone_number": "541-947-2114",
            "fax_number": "541-947-2433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE HEALTH DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "DYBDAL",
        "authorized_official_first_name": "LANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-947-2114"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "OR",
            "license": "140896",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OR",
            "license": "140896",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OR",
            "license": "1836773096",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAIDORE.HEALTHL.T.C.",
            "identifier": "802595",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106146",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OREGON HEALTH",
            "identifier": "107532",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake District Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake District Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeview, OR

Sources for this page

Verify at the official NPI Registry.