NPIMap

Organization Active NPI

Lake Regional Health System

Doing business as Lake Regional Hospice

  • Community Based Hospice Care Agency
  • Osage Beach, MO
National Provider Identifier
1417492091
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
Lake Regional Hospice
Practice address
1029 Nichols Rd Ste a
Osage Beach, MO 65065-3702
Phone
(573) 302-2860
NPI assigned
Jan 5, 2017
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary
Inpatient Hospice 315D00000X NU

Addresses

Primary practice location

1029 Nichols Rd Ste a
Osage Beach, MO 65065-3702

Mailing address

54 Hospital Dr
Osage Beach, MO 65065-3050
Phone (573) 302-2860

Other identifiers 1

IdentifierTypeStateIssuer
820052478MedicaidMO

Other names 1

  • Lake Regional Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170119001163 MO Part A Provider - Hospice 9133026776 Practice locations: Osage Beach, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417492091. Details of each certification follow.

Hospice certification: CCN 261672

Legal name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
LAKE REGIONAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 9, 2017
Last certification
Aug 15, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 20, 1973 in MO
Enrollment address
1029 Nichols Rd
Ste a
Osage Beach, MO 65065-3702

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Lake Regional HospiceCCN 261672 · All quality measures
Ownership
For-Profit
Certified
Jan 9, 2017
Medicare certification status
ActiveFrom the Provider of Services file

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
26D0698107Lake Regional Hospice1029 Nichols Road Building 3, Osage Beach, MO 65065Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Lake of the Ozarks Gene20 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

Locations

1193 Highway KK
Osage Beach, MO 65065
Phone (573) 302-2860

Ownership & related parties

All disclosed owners & managing parties 22

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 OfficerSecretary Jun 30, 2016
Corporate DirectorBoard Member Oct 1, 2009
John C Patton Individual Corporate DirectorBoard Member Jan 1, 2017
Karen K. Faiferlick Individual Corporate OfficerPresident Jun 3, 2022
Corporate DirectorBoard Member Jun 30, 2016
Christine a Livek Individual W-2 Managing EmployeeMD; Jan 6, 2021
Gregory D Anderson Individual Corporate DirectorBoard Member Oct 1, 1994
Courtney Hulett Individual W-2 Managing EmployeeAd; Sep 1, 2023
Kevin G McRoberts Individual Corporate OfficerCeo Jan 3, 2022
Operational/Managerial ControlCeo Jan 4, 2022
Charles McElyea Individual Corporate OfficerAssistant Secretary Jun 30, 2016
Corporate DirectorBoard Member Jun 1, 1992
Mark Rector Individual Corporate DirectorBoard Member Jun 4, 2021
Warren T Cooper Individual Corporate DirectorBoard Member-Chief of Staff Jun 6, 2024
Alan W Mead Individual Corporate DirectorBoard Member Jan 1, 2017
Paula Littleton Individual Corporate OfficerCfo Jul 22, 2024
Operational/Managerial ControlCfo Jul 22, 2024
Jason Hulett Individual Corporate OfficerVice President Jun 3, 2022
Corporate DirectorBoard Member Jun 4, 2021
Jessica Hasty Individual W-2 Managing EmployeeManaged Care Coordinator Feb 1, 2016
Corey M Tenbensel Individual Corporate DirectorBoard Member Jun 3, 2011
Melissa Hunter Individual Contracted Managing EmployeeCno/Coo Apr 1, 2022
Corporate OfficerCno/Coo Apr 1, 2022
Larry Shields Individual Corporate DirectorBoard Member Oct 1, 1975
John Caine Individual Corporate DirectorBoard Member Jan 1, 2017
Kevin G Byrne Individual Corporate OfficerBoard Member Oct 1, 2004
Kristen L Prenger Individual W-2 Managing EmployeeDirector of Managed Care Jan 1, 2024
Operational/Managerial ControlDirector of Managed Care Jan 1, 2024
Wayne Compton Individual Corporate OfficerTreasurer Jun 30, 2016
James D. Judas Individual Corporate DirectorBoard Member Jun 7, 2013

Owners & managing parties with NPI records 5

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": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1417492091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 HOSPITAL DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-302-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 NICHOLS RD STE A",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653702",
            "telephone_number": "573-302-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "820052478",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Regional Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Regional Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.