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Organization Active NPI

Our Lady of the Lake Hospital, Inc.

  • 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.
Practice address
5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone
(225) 765-6565
Fax
(225) 767-1159
NPI assigned
Oct 5, 2005
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 12

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same 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.

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

Facilities with the same owner 19

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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

Medicare Care Compare: Inpatient rehabilitation facility

Listed as
Our Lady of the Lake Regional Medical Center CCN 19T064
Ownership
Non-profit
Certified
Jul 1, 1986

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

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
Corporation · Proprietary
Enrollment address
5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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 Control
Fmolhs President & Ceo		 Feb 20, 2018
Jennifer J Clowers
Individual 		Corporate Officer Aug 1, 2022
W-2 Managing Employee Aug 1, 2022

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 Louisiana
Baton Rouge, LA · CCN 190266		 Hospital 5% Or Greater Direct Ownership Interest (35%) Jan 31, 2022
Surgical Specialty Center of Baton Rouge
Baton Rouge, LA · CCN 190251		 Hospital 5% Or Greater Direct Ownership Interest (49%) Aug 31, 2008
Fmol Health| Our Lady of the Lake
Baton Rouge, LA · CCN 19S064		 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1990
Our Lady of the Lake Surgical Hospital
Slidell, LA · CCN 190270		 Hospital 5% Or Greater Indirect Ownership Interest (33.06%) Oct 1, 2015
Our Lady of the Lake Assumption Community Hospital
Napoleonville, LA · CCN 190779		 Hospital 5% Or Greater Direct Ownership Interest May 25, 2001
Our Lady of the Lake Regional Medical Center
Baton 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 Zachary
Zachary, LA · CCN 197607		 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 18, 2017
Pinnacle Home Health of Baton Rouge
Baton Rouge, LA · CCN 197770		 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 18, 2017
Pinnacle Hospice
Baton 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 Roads
New Roads, LA · CCN 193856		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2010
Fmol Health Assumption Rural Health
Napoleonville, LA · CCN 193426		 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 22, 1997
Our Lady of the Lake Physician Group LLC
Maurepas, LA · CCN 193876		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2010

Medicare enrollment records

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

National Provider Directory

Tax ID family
Industrial Family Medic (10 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

NPPES NPI Registry

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 24, 2022.

{
    "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.