NPIMap

Organization Active NPI

Lake Regional Health System

Doing business as Lake Regional Foot & Ankle Surgery

  • Durable Medical Equipment & Medical Supplies
  • Osage Beach, MO
National Provider Identifier
1386926939
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
Lake Regional Foot & Ankle Surgery
Practice address
1075 Nichols Rd
Suite 1-2
Osage Beach, MO 65065-3093
Phone
(573) 302-2828
Fax
(573) 302-2830
NPI assigned
Sep 9, 2011
Last updated
May 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Authorized official

Name
Paula Sue Littleton
Title
Cfo
Phone
(573) 348-8388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1075 Nichols Rd
Suite 1-2
Osage Beach, MO 65065-3093

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3928520002OtherMODME PTAN
501945604MedicaidMO

Other names 1

  • Lake Regional Foot & Ankle Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111219000386 MO DME Supplier - Physician - Podiatry 3577467323 Practice locations: Osage Beach, MO

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Micheal Ledbetter DO2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1386926939",
    "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": "1075 NICHOLS RD",
            "address_2": "SUITE 1-2",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653093",
            "telephone_number": "573-302-2828",
            "fax_number": "573-302-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-09",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "LITTLETON",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-348-8388"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME PTAN",
            "identifier": "3928520002",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501945604",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Regional Foot & Ankle Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.