NPIMap

Organization Active NPI

Lake Regional Health System

Doing business as Lake Regional Clinic - Camdenton

  • Rural Health Clinic/Center
  • Camdenton, MO
National Provider Identifier
1437440856
Registry record updated Oct 13, 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 Clinic - Camdenton
Practice address
1930 N Business Route 5
Unit 1a
Camdenton, MO 65020-2659
Phone
(573) 346-5624
Fax
(573) 346-1957
NPI assigned
Apr 20, 2011
Last updated
Oct 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 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

1930 N Business Route 5
Unit 1a
Camdenton, MO 65020-2659

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1437440856MedicaidMO

Other names 1

  • Lake Regional Clinic - Camdenton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140403001063 MO Part A Provider - Rural Health Clinic 9133026776 1 other NPI on this enrollment
Practice locations: Camdenton, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437440856. Details of each certification follow.

Rural health clinic certification: CCN 268707

Legal name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
LAKE REGIONAL CLINIC CAMDENTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2014
Last certification
Feb 3, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1995 in MO
Enrollment address
1930 N Business Route 5 1a
Camdenton, MO 65020-2659
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

Other NPIs on the same Medicare enrollment 1

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

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
26D0445822Lake Regional Clinic-Camdenton1930 N Business Hwy 5 Unit 1 a, Camdenton, MO 65020AccreditationOct 6, 2026

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

Member of 2

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

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 DirectorBoard Member Oct 1, 2009
John C Patton Individual Corporate DirectorBoard Member Jun 3, 2022
Karen K. Faiferlick Individual Corporate OfficerPresident Jun 3, 2022
Corporate DirectorBoard Member Jun 30, 2016
Gregory D Anderson Individual Corporate DirectorBoard Member Oct 1, 1994
Kevin G McRoberts Individual Corporate OfficerCeo Jan 3, 2022
Charles McElyea Individual Corporate OfficerAssistant Secretary Jun 30, 2016
Corporate DirectorBoard Member Nov 1, 2014
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 Aug 4, 2015
Paula Littleton Individual Corporate OfficerCfo 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
Larry Shields Individual Corporate DirectorBoard Member Oct 1, 1975
John Caine Individual Corporate DirectorBoard Member Jun 1, 1999
Kevin G Byrne Individual Corporate DirectorBoard Member Oct 1, 2004
Kristen L Prenger Individual Operational/Managerial ControlDirector of Managed Care Jan 1, 2024
Wayne Compton Individual Corporate OfficerTreasurer Jun 1, 2002
James D. Judas Individual Corporate DirectorBoard Member Jun 7, 2013

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": "1303257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1437440856",
    "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": "1930 N BUSINESS ROUTE 5",
            "address_2": "UNIT 1A",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650202659",
            "telephone_number": "573-346-5624",
            "fax_number": "573-346-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-20",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437440856",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Regional Clinic - Camdenton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Regional Clinic - Camdenton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camdenton, MO

Sources for this page

Verify at the official NPI Registry.