NPIMap

Organization Active NPI

Lakewood Health System

  • Nursing Facility/Intermediate Care Facility
  • Staples, MN
National Provider Identifier
1699766733
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
376427 Issued in MN
Legal business name
LAKEWOOD HEALTH SYSTEM
Practice address
401 Prairie Ave NE
Staples, MN 56479-3201
Phone
(218) 894-1515
Fax
(218) 898-7596
NPI assigned
Oct 28, 2005
Last updated
Jun 9, 2025By the provider in NPPES
Organization subpart
No

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 T Reycraft
Title
Cfo
Phone
(218) 894-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 376427 MN Primary

Addresses

Primary practice location

401 Prairie Ave NE
Staples, MN 56479-3201

Mailing address

401 Prairie Ave NE
Staples, MN 56479-3201
Phone (218) 894-1515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130627000386 MN Part A Provider - Skilled Nursing Facility 1052229671 Practice locations: Staples, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699766733. Details of each certification follow.

Skilled nursing facility certification: CCN 245420A

Legal name
LAKEWOOD HEALTH SYSTEM
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1997 in MN
Enrollment address
401 Prairie Ave NE
Staples, MN 56479-3201
Nursing home name
LAKEWOOD HEALTH SYSTEM

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

National Provider Directory

National Provider Directory
Tax ID family
North Memorial Health Care14 organizations share this tax ID, including this one

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 disclosed owners & managing parties 33

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

NameRoleSinceShare
Melissa Beth Lindow Individual Operational/Managerial ControlVP of Operations Aug 27, 2023
Billy Joe Haehnel Individual Corporate DirectorBoard Member Nov 1, 2015
Joseph Thomas Reycraft Individual Corporate OfficerCfo Aug 28, 2022
Operational/Managerial ControlCfo Aug 28, 2022
Curtis Eugene McIlravy Individual Corporate OfficerSystem Board Chair Jul 1, 2014
Ryan David Kray Individual Corporate DirectorBoard Member Oct 1, 2021
Robert Michael Mueller Individual Corporate DirectorBoard Member Jun 25, 2015
Sara Jane Grove Individual Corporate DirectorBoard Member Apr 24, 2014
Craig Thomas Wolhowe Individual Corporate OfficerVP Jun 11, 1997
Operational/Managerial ControlVP of Clinic and Hospital Services Jun 11, 1997
Alicia Kay Bauman Individual Operational/Managerial ControlVP of Perform. Excellence & Talent Oct 9, 2022
Mary Martha Theurer Individual Corporate OfficerDistrict Chair / System Secretary Jan 1, 2010
Elizabeth Ann Pottratz Individual Corporate DirectorBoard Member Jan 1, 2023
Lisa Marie Bjerga Individual Corporate OfficerCeo/President Mar 7, 2016
Operational/Managerial ControlCeo/President Mar 7, 2016
Kaitlyn Rose Schoeck Individual Corporate DirectorBoard Member Aug 7, 2017
Lana Ellen Hansen Individual Corporate DirectorDistrict Secretary Jan 1, 2008
Ronald Alvin Storbakken Individual Corporate DirectorBoard Member Jan 1, 2000
Kevin Lee Nelson Individual Corporate DirectorSystem Treasurer Apr 1, 2018
Kathleen Marie Dobson Individual Operational/Managerial ControlVP of Senior Services Dec 1, 2014
Judith Ann Bjerga Individual Corporate DirectorDistrict Vice Chair Jan 1, 2007
James Alan Roeder Individual Operational/Managerial ControlVice President of It Oct 15, 2017
Brad Richard Anderson Individual Operational/Managerial ControlVP of Strategy and Development Aug 13, 2014
Amy Jo Brichacek Individual Corporate DirectorBoard Member Jan 1, 2021
Emil Paul Wicht Individual Corporate DirectorBoard Member Jan 1, 1973
Corrine Marie Neisess Individual Operational/Managerial ControlVP of Nursing Sep 1, 2018
Melissa Sue Daniels Individual W-2 Managing EmployeeExecutive Assistant to the Cfo Sep 15, 2016
Norman Harold Krause Individual Corporate DirectorBoard Member Jul 1, 2018
Susan Kay Peet Individual Corporate DirectorBoard Member Jan 1, 2021
Wade Thomas Swenson Individual Corporate DirectorBoard Member Jan 1, 2023
Lindsay Rae Leveille Individual Corporate DirectorBoard Member Jul 1, 2023
Stephanie Marie Jordahl Individual Corporate DirectorBoard Member Jul 1, 2021
Christine Sara Albrecht Individual Operational/Managerial ControlCmo Jun 1, 2020
Lynn Marie Newton Rice Individual Operational/Managerial ControlVP of Support Services Jun 30, 1980
Beverly Jean Hoemberg Individual Corporate DirectorBoard Member Jan 1, 2011
Jef Richard Cichos Individual Corporate DirectorSystem Vice Chair Jul 1, 2016

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 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

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": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1699766733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 PRAIRIE AVE NE",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564793201",
            "telephone_number": "218-894-1515",
            "fax_number": "218-898-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PRAIRIE AVE NE",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564793201",
            "telephone_number": "218-894-1515",
            "fax_number": "218-898-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "REYCRAFT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-894-8194"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MN",
            "license": "376427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staples, MN

Sources for this page

Verify at the official NPI Registry.