NPIMap

Organization Active NPI

Lakewood Health System

Doing business as Longbella Drug by Lakewood Health System - Staples Clinic

  • Community/Retail Pharmacy
  • Staples, MN
National Provider Identifier
1508630112
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LAKEWOOD HEALTH SYSTEM
Doing business as
Longbella Drug by Lakewood Health System - Staples Clinic
Practice address
49725 County 83 Ste 100
Staples, MN 56479-5280
Phone
(218) 894-8761
Fax
(218) 894-8762
NPI assigned
Nov 14, 2023
Last updated
Jun 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKEWOOD HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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

Authorized official

Name
Joseph Reycraft
Title
Cfo
Phone
(218) 894-8194

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

49725 County 83 Ste 100
Staples, MN 56479-5280

Mailing address

49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515

Other identifiers 1

IdentifierTypeStateIssuer
266847OtherMNSTATE LICENSE

Other names 1

  • Longbella Drug by Lakewood Health System - Staples Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231219003831 MN DME Supplier - Pharmacy 1052229671 Practice locations: Staples, MN
O20231228001019 MN Part B Supplier - Pharmacy 1052229671 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pillager, MN; Staples, MN

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Lakewood Health System14 organizations share this tax ID, including this one
Part of
Lakewood Health System

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Lakewood ClinicStaples, MN, CCN 243422 Rural health clinic 5% Or Greater Direct Ownership Interest
General Partnership Interest		 Apr 1, 1997
Apr 1, 1997
Lakewood Clinic-BrowervilleEagle Bend, MN, CCN 243421 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1997
Lakewood Clinic-PillagerPillager, MN, CCN 243436 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Mar 1, 1998
Mar 1, 1998

Owned or controlled facilities with NPI records 3

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

  • Lakewood Health System

    dba Lakewood Clinic Eagle Bend

    • Rural Health Clinic/Center
    • Eagle Bend, MN
    • NPI 1093706160

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Lakewood Health System

    dba Lakewood Clinic Pillager

    • Rural Health Clinic/Center
    • Pillager, MN
    • NPI 1811988983

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Lakewood Health System

    dba Lakewood Clinic Staples

    • Rural Health Clinic/Center
    • Staples, MN
    • NPI 1841280823

    5% Or Greater Direct Ownership Interest, General Partnership Interest

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1508630112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83 STE 100",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-8761",
            "fax_number": "218-894-8762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKEWOOD HEALTH SYSTEM",
        "enumeration_date": "2023-11-14",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "REYCRAFT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-894-8194"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "266847",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longbella Drug by Lakewood Health System - Staples Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staples, MN

Sources for this page

Verify at the official NPI Registry.