Mayo Clinic Health System-Lake City

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MAYO CLINIC HEALTH SYSTEM-LAKE CITY

Practice address

500 W Grant St
Lake City, MN 55041-1143

Phone

(651) 345-3321

Fax

(651) 345-1151

NPI assigned

Jun 8, 2006

Last updated

Apr 16, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Morris Miller

Title

Cfo

Phone

(507) 594-6449

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831130319. Details of each certification follow.

• CCN 245218B Skilled nursing facility · Details

Skilled nursing facility certification: CCN 245218B

Legal name

MAYO CLINIC HEALTH SYSTEM-LAKE CITY

Organization structure

CorporationNon-profit

Enrollment address

500 W Grant St
Lake City, MN 55041-1143

Nursing home name

MAYO CLINIC HEALTH SYSTEM - LAKE CITY

Other NPIs with the same Medicare PAC ID 3

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

• Mayo Clinic Health System-Lake City

  • Multi-Specialty Clinic/Center
  • Lake City, MN
  • NPI 1164463659

  1951213487

  Same PAC ID
• Mayo Clinic Health System-Lake City

  • Critical Access Hospital
  • Lake City, MN
  • NPI 1538113022

  1951213487

  Same PAC ID
• Mayo Clinic Health System-Lake City

  • Medicare Defined Swing Bed Hospital Unit
  • Lake City, MN
  • NPI 1891710893

  1951213487

  Same PAC ID

Tax ID family

Mayo Clinic- Lake City4 organizations share this tax ID, including this one

Part of

Mayo Clinic- Lake City

Other organizations with this tax ID 3

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

• Mayo Clinic Health System-Lake City

  • Non-Pharmacy Dispensing Site
  • Lake City, MN
  • NPI 1447863972
  NPD tax ID
• Mayo Clinic Health System-Lake City

  • Critical Access Hospital
  • Lake City, MN
  • NPI 1538113022
  NPD tax ID
• Mayo Clinic Health System-Lake City

  • Medicare Defined Swing Bed Hospital Unit
  • Lake City, MN
  • NPI 1891710893
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mayo Clinic

  • Air Ambulance
  • Rochester, MN
  • NPI 1821326570

  Member Of

  NPD member

All disclosed owners & managing parties 67

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

Owners & managing parties with NPI records 26

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

• Trent D Anderson, D.O.

  • Family Medicine Physician
  • Lake City, MN
  • NPI 1366751927

  Corporate Director

  CMS ownership
• Gokhan Anil, MD

  • Obstetrics & Gynecology Physician
  • Mankato, MN
  • NPI 1902928153

  Managing Control - Governing Body

  CMS ownership
• Brian N Bartlett, MD

  • Emergency Medicine Physician
  • Rochester, MN
  • NPI 1790973782

  Managing Control - Governing Body

  CMS ownership
• Taylor R Beahrs, MD

  • Orthopaedic Surgery Physician
  • Mankato, MN
  • NPI 1255690996

  Managing Control - Governing Body

  CMS ownership
• Matthew R Callstrom, M.D.

  • Diagnostic Radiology Physician
  • Rochester, MN
  • NPI 1316925621

  Managing Control - Governing Body

  CMS ownership
• Nneka I Comfere, M.D.

  • Dermatology Physician
  • Rochester, MN
  • NPI 1386623551

  Managing Control - Governing Body

  CMS ownership
• Ebenezer Management Services Inc

  • Long Term Care Pharmacy
  • Arden Hills, MN
  • NPI 1962355073

  Operational/Managerial Control

  CMS ownership
• Abimbola O Famuyide, M.B.B.S.

  • Obstetrics & Gynecology Physician
  • Rochester, MN
  • NPI 1457338774

  Managing Control - Governing Body

  CMS ownership
• Randy M Foss, MD

  • Family Medicine Physician
  • Lake City, MN
  • NPI 1083903033

  Adp of the SNF, Corporate Director, Corporate Officer, Operational/Managerial Control

  CMS ownership
• Karthik Ghosh, M.D.

  • Internal Medicine Physician
  • Rochester, MN
  • NPI 1972582815

  Corporate Officer

  CMS ownership
• Albert R Harris, M.D.

  • Surgery of the Hand (Plastic Surgery) Physician
  • Mankato, MN
  • NPI 1952506214

  Managing Control - Governing Body

  CMS ownership
• Katie Hinderaker, MD

  • Family Medicine Physician
  • Rochester, MN
  • NPI 1548615255

  Corporate Director

  CMS ownership

Facilities with the same owner 45

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Charterhouse Inc

  • Skilled Nursing Facility
  • Rochester, MN
  • NPI 1083601843

  Mayo Clinic

  CMS ownership
• Ebenezer Lakes Assisted Living

  dba Meadows on Fairview

  • Skilled Nursing Facility
  • Wyoming, MN
  • NPI 1679916571

  Ebenezer Management Services Inc

  CMS ownership
• Ebenezer Ridges

  • Skilled Nursing Facility
  • Burnsville, MN
  • NPI 1265433767

  Ebenezer Management Services Inc

  CMS ownership
• Ebenezer Society

  dba Ebenezer Care Center

  • Skilled Nursing Facility
  • Minneapolis, MN
  • NPI 1184622870

  Ebenezer Management Services Inc

  CMS ownership
• Edina Senior Living, LLC

  dba Aurora on France

  • Skilled Nursing Facility
  • Edina, MN
  • NPI 1669921912

  Ebenezer Management Services Inc

  CMS ownership
• Itasca Nursing Home

  dba Grand Village

  • Skilled Nursing Facility
  • Grand Rapids, MN
  • NPI 1184662793

  Ebenezer Management Services Inc

  CMS ownership
• Jones Harrison Residence Corporation

  • Skilled Nursing Facility
  • Minneapolis, MN
  • NPI 1699762195

  Ebenezer Management Services Inc

  CMS ownership
• Martin LM LLC

  dba Martin Luther Care Center

  • Skilled Nursing Facility
  • Bloomington, MN
  • NPI 1629148929

  Ebenezer Management Services Inc

  CMS ownership
• Mayo Clinic Health System-Fairmont

  • Medicare Defined Swing Bed Hospital Unit
  • Fairmont, MN
  • NPI 1740258318

  Mayo Clinic

  CMS ownership
• Mayo Clinic Health System-Fairmont

  • General Acute Care Hospital
  • Fairmont, MN
  • NPI 1821066499

  Mayo Clinic

  CMS ownership
• Mayo Clinic Health System-Lake City

  • Critical Access Hospital
  • Lake City, MN
  • NPI 1538113022

  Mayo Clinic

  CMS ownership
• Mayo Clinic Health System-Lake City

  • Medicare Defined Swing Bed Hospital Unit
  • Lake City, MN
  • NPI 1891710893

  Mayo Clinic

  CMS ownership

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.

• Randy M Foss, MD

  • Family Medicine Physician
  • Lake City, MN
  • NPI 1083903033
  NPD (past)
• Brian E. Kelly, MD

  • Family Medicine Physician
  • Wabasha, MN
  • NPI 1659341212
  NPD (past)
• Kyle M McKenzie, MD

  • Internal Medicine Physician
  • Rochester, MN
  • NPI 1942595012
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1831130319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W GRANT ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411143",
            "telephone_number": "651-345-3321",
            "fax_number": "651-345-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W GRANT ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411143",
            "telephone_number": "651-345-3321",
            "fax_number": "651-345-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO CLINIC HEALTH SYSTEM-LAKE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "507-594-6449"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "715522100",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd SteB",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ann Marie Lowe, M.D.
• Reid Lundell
• Mayo Clinic Health System-Lake City
• Mayo Clinic Health System-Lake City
• Mayo Clinic Health System-Lake City
• Mayo Clinic Health System-Lake City
• Mayo Clinic Hospital-Rochester
• Patience S Mbonifor, RN, DNP
• Srdjan Milosavljevic, PA-C
• Tina Marie Montgomery, M.S. CCC/SLP

• Skilled Nursing Facility in Lake City, MN
• Providers in Lake City, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.