NPIMap

Organization Active NPI

Lake Health District

  • Rural Health Clinic/Center
  • Lakeview, OR
National Provider Identifier
1699183236
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAKE HEALTH DISTRICT
Practice address
700 South J St
Lakeview, OR 97630
Phone
(541) 947-2114
NPI assigned
Jul 28, 2014
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Jennifer Antle
Title
Payor Relations Manager
Phone
(541) 219-2904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

700 South J St
Lakeview, OR 97630

Mailing address

700 S J St
Lakeview, OR 97630-1623
Phone (541) 947-2114

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140812002506 OR Part A Provider - Rural Health Clinic 4284629221 Practice locations: Lakeview, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699183236. Details of each certification follow.

Rural health clinic certification: CCN 388517

Legal name
LAKE HEALTH DISTRICT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2015
Last certification
Aug 2, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jul 18, 1967 in OR
Enrollment address
700 S J St
Lakeview, OR 97630-1623
Related CCNs
381309

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

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
Tax ID family
Lake District Hosptial8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Lake Health District Organization, Lakeview, OR Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2014 100%
Cheryl J Cornwell Individual Corporate Officer Sep 16, 2013
W-2 Managing Employee Aug 1, 2014
Landon Dybdal Individual 5% Or Greater Direct Ownership InterestCeo Jan 1, 2024 5%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1699183236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S J ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301623",
            "telephone_number": "541-947-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SOUTH J ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "97630",
            "telephone_number": "541-947-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-28",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "ANTLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PAYOR RELATIONS MANAGER",
        "authorized_official_telephone_number": "541-219-2904"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeview, OR

Sources for this page

Verify at the official NPI Registry.