NPIMap

Organization Active NPI

Our Lady of the Lake Hospital, Inc.

Doing business as Our Lady of the Lake Regional Medical Center

  • Rehabilitation Hospital Unit
  • Baton Rouge, LA
National Provider Identifier
1497742365
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
OUR LADY OF THE LAKE HOSPITAL, INC.
Doing business as
Our Lady of the Lake Regional Medical Center
Practice address
5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone
(225) 765-6565
Fax
(225) 767-1159
NPI assigned
Oct 5, 2005
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Mr. Robert C. Davidge
Title
Chief Executive Officer
Phone
(225) 765-7702

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

Primary practice location

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375

Mailing address

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone (225) 765-7702

Other names 1

  • Our Lady of the Lake Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100226000632 LA Part A Provider - Hospital 0547254377 Practice locations: Baton Rouge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497742365. Details of each certification follow.

Hospital certification: CCN 19T064

Legal name
OUR LADY OF THE LAKE HOSPITAL INC
Doing business as
OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER
Organization structure
CorporationProprietary
Enrollment address
5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Our Lady of the Lake Regional Medical CenterCCN 19T064 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1986

National Provider Directory

National Provider Directory
Tax ID family
Our Lady of the Lake Re10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Our Lady of the Lake Hospital Inc Organization, Baton Rouge, LA 5% Or Greater Direct Ownership Interest Jan 1, 1986
Franciscan Missionaries of Our Lady Health System Inc Organization, Baton Rouge, LA Corporation 5% Or Greater Direct Ownership Interest Jul 1, 1966
Richard Vath Individual Operational/Managerial ControlFmolhs President & Ceo Feb 20, 2018
Jennifer J Clowers Individual Corporate Officer Aug 1, 2022
W-2 Managing Employee Aug 1, 2022

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 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Spine Hospital of LouisianaBaton Rouge, LA, CCN 190266 Hospital 5% Or Greater Direct Ownership Interest (35%) Jan 31, 2022
Surgical Specialty Center of Baton RougeBaton Rouge, LA, CCN 190251 Hospital 5% Or Greater Direct Ownership Interest (49%) Aug 31, 2008
Fmol Health| Our Lady of the LakeBaton Rouge, LA, CCN 19S064 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1990
Our Lady of the Lake Surgical HospitalSlidell, LA, CCN 190270 Hospital 5% Or Greater Indirect Ownership Interest (33.06%) Oct 1, 2015
Our Lady of the Lake Assumption Community HospitalNapoleonville, LA, CCN 190779 Hospital 5% Or Greater Direct Ownership Interest May 25, 2001
Our Lady of the Lake Regional Medical CenterBaton Rouge, LA, CCN 195566 Skilled nursing facility 5% Or Greater Direct Ownership Interest
Adp of the SNF		 May 15, 2003
Dec 20, 2024
Pinnacle Home Health of ZacharyZachary, LA, CCN 197607 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 18, 2017
Pinnacle Home Health of Baton RougeBaton Rouge, LA, CCN 197770 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 18, 2017
Pinnacle HospiceBaton Rouge, LA, CCN 191662 Hospice 5% Or Greater Direct Ownership Interest (80%)
5% Or Greater Indirect Ownership Interest (100%)		 Jun 18, 2017
Jun 18, 2017
Our Lady of the Lake Physician Group New RoadsNew Roads, LA, CCN 193856 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2010
Fmol Health Assumption Rural HealthNapoleonville, LA, CCN 193426 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 22, 1997
Our Lady of the Lake Physician Group LLCMaurepas, LA, CCN 193876 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2010

Owned or controlled facilities with NPI records 12

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

Facilities with the same owner 19

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 19

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1497742365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084375",
            "telephone_number": "225-765-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084375",
            "telephone_number": "225-765-6565",
            "fax_number": "225-767-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF THE LAKE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "DAVIDGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "225-765-7702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Our Lady of the Lake Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Our Lady of the Lake Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.