Lake Health District
Organization Active NPI Critical Access Hospital · Lakeview, OR
NPI 1376698522 · NPPES record last updated Jul 16, 2026
Key facts
- NPI
- 1376698522
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 140896 (OR)
- Legal business name
- LAKE HEALTH DISTRICT
- Practice address
- 700 S J St
Lakeview, OR 97630-1623 - Phone
- (541) 947-2114
- Fax
- (541) 947-2433
- NPI assigned
- Jan 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Landon Dybdal
- Title
- Ceo
- Phone
- (541) 947-2114
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Member of 1
Related certifications (CCN) 1
Practitioners 87
-
David Marshall Ager, D.C.
-
Matthew Ross Bentz, M.D.
-
Ryan E Berecky, MD
-
Michelle T Black, MD
-
Taylor Brown, MD
-
Lesa L Cahill, FNP
-
Jason Paul Doye, MD
-
Benjamin English, MD
-
Rosanne Fitzgerald, FNP-BC
-
Timothy A Gallagher, M.D.
-
David Greenberg, MD
-
Walter C Griffin, DO
-
Stephen B Haltom, MD
-
Kevin T Heaton, DO
-
Kai Kinder, M.D.
Affiliated clinicians 82
-
Gillian Bayley, M.D.
-
Nicholas Song Boehling, M.D.
-
Mark F Bradbury, M.D.
-
Lesa L Cahill, FNP
-
Todd Clover, MD
-
Charles Keith Cofas, M.D.
-
Bryden Considine, DO
-
Kerry Councilman, MD
-
Kara Davis Faith, PAC
-
Anna Marie Dolezal, M.D.
-
Kenneth Downs, FNP
-
Ryan Dutton, PA-C
-
Matthew Sean Edmonds, M.D.
-
Jeremy P Feldman, M.D.
-
Rosanne Fitzgerald, FNP-BC
-
Timothy A Gallagher, M.D.
-
Charles Scott Graham, D.O.
-
Anthony G Hadden, M.D.
-
Kevin T Heaton, DO
Medicare Care Compare: Hospital
- Listed as
- Lake District Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2008921 | Lake District Hospital EMS | Certificate of waiver | Jun 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (9 enrollments) in OR, UT, NY, NM, CO, CA
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
- Other · Non-profit
- Incorporated
- Jul 18, 1967 in OR
- Enrollment address
- 700 S J St
Lakeview, OR 97630-1623
Hospital certification: CCN 38Z309
- Legal name
- LAKE HEALTH DISTRICT
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 18, 1967 in OR
- Enrollment address
- 700 S J St
Lakeview, OR 97630-1623
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Jennifer Antle |
Operational/Managerial Control |
Aug 1, 2024 | |
| W-2 Managing Employee | Aug 1, 2024 | ||
| Landon Dybdal |
Corporate Officer |
Jan 1, 2024 | 100% |
| W-2 Managing Employee |
Apr 1, 2024 | 100% | |
| Jane H O'Keeffe |
Corporate Director |
Jun 10, 2016 | |
| Jerald Steward |
Corporate Director |
Jun 27, 2016 | |
| Don Liddycoat |
Corporate Director |
Jun 27, 2016 | |
| Cheryl J Cornwell |
Operational/Managerial Control | Sep 16, 2013 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Lake Health District |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
922 S 7th St
Lakeview, OR 97630
Phone (503) 947-3357
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital Clinic/Center | 261QC0050X | 140896 | OR | |
| Critical Access Hospital | 282NC0060X | 140896 | OR | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107532 | Other | OR | MEDICAID OREGON HEALTH |
| 106146 | Medicaid | OR | |
| 802595 | Other | OR | MEDICAIDORE.HEALTHL.T.C. |
Other names
- Lake District Hospital
Other providers in Lakeview, OR
- Lake County Mental Health
- Lake County School District #7
- Lake District Health
- Lake District Hospital Physicians Group
- Lake Health District
- Lake Health District
- Lake Health District
- Lake Health District
- Lake Health District
- Lake Health District
All providers in Lakeview, OR · Critical Access Hospital in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.