NPIMap

Organization Active NPI

Lake Regional Health System

  • Land Ambulance
  • Osage Beach, MO
National Provider Identifier
1720840200
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
LAKE REGIONAL HEALTH SYSTEM
Practice address
54 Hospital Dr
Osage Beach, MO 65065-3050
Phone
(573) 348-8000
Fax
(573) 348-8391
NPI assigned
Jan 29, 2024
Last updated
Jan 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Authorized official

Name
Kevin McRoberts, FACHE
Title
Ceo
Phone
(573) 348-8756

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X NU
Land Ambulance 3416L0300X NU Primary

Addresses

Primary practice location

54 Hospital Dr
Osage Beach, MO 65065-3050

Mailing address

54 Hospital Dr
Osage Beach, MO 65065-3050
Phone (573) 348-8000

Other names 1

  • LRHS-AMBULANCE Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241122002328 MO Part B Supplier - Ambulance Service Supplier 9133026776 Practice locations: Osage Beach, MO

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Lake of the Ozarks Gene20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lake Regional Health SystemOsage Beach, MO, CCN 265429 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Nov 23, 2006
Jan 3, 2025
Feb 23, 2006

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1720840200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 HOSPITAL DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-348-8000",
            "fax_number": "573-348-8391"
        },
        {
            "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": "573-348-8000",
            "fax_number": "573-348-8391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "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_credential": "FACHE"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LRHS-AMBULANCE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.