NPIMap

Organization Active NPI

Lake Regional Medical Management, Inc.

Doing business as Lake Regional Medical Group

  • Multi-Specialty Clinic/Center
  • Osage Beach, MO
National Provider Identifier
1639134158
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LAKE REGIONAL MEDICAL MANAGEMENT, INC.
Doing business as
Lake Regional Medical Group
Practice address
54 Hospital Dr
Osage Beach, MO 65065-3050
Phone
(573) 348-8074
Fax
(573) 348-8069
NPI assigned
Apr 18, 2006
Last updated
Nov 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Authorized official

Name
Mr. Kevin McRoberts
Title
Ceo
Phone
(573) 348-8756

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

54 Hospital Dr
Osage Beach, MO 65065-3050

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
501945604MedicaidMO

Other names 1

  • Lake Regional Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031122000076 MO Part B Supplier - Clinic/Group Practice 3577467323 Receives reassigned benefits from 48 practitioners
Practice locations: Saint Robert, MO; Richland, MO; Osage Beach, MO; Lebanon, MO; Gravois Mills, MO; Eldon, MO

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

416 S Maple St
Ste C
Eldon, MO 65026
Phone (573) 302-2764

441 W Elm St
Lebanon, MO 65536
Phone (417) 532-2805

1029 Nichols Rd
Ste 201
Osage Beach, MO 65065
Phone (573) 302-7138

1029 Nichols Rd
Ste 301
Osage Beach, MO 65065
Phone (573) 302-2864

1075 Nichols Rd
Ste 7
Osage Beach, MO 65065
Phone (573) 348-2111

54 Hospital Dr
Ste 204
Osage Beach, MO 65065
Phone (573) 302-3960

54 Hospital Dr
Ste 213
Osage Beach, MO 65065
Phone (573) 302-3199

54 Hospital Dr
Ste G
Osage Beach, MO 65065
Phone (573) 302-2715

Practitioners & affiliated clinicians

Practitioners 51

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.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1639134158",
    "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": "54 HOSPITAL DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-348-8074",
            "fax_number": "573-348-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL MEDICAL MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501945604",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.