NPIMap

Organization Active NPI

Lake Regional Health System

  • Skilled Nursing Facility
  • Osage Beach, MO
National Provider Identifier
1831164615
Registry record updated Jul 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
291-28 Issued in MO
Legal business name
LAKE REGIONAL HEALTH SYSTEM
Practice address
54 Hospital Drive
Osage Beach, MO 65065-3050
Phone
(573) 348-8000
Fax
(573) 348-8069
NPI assigned
Feb 23, 2006
Last updated
Jul 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 291-28 MO Primary

Addresses

Primary practice location

54 Hospital Drive
Osage Beach, MO 65065-3050

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 2.16.840.1.113883.17.9.1 Other Craneware, Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080116000229 MO Part A Provider - Skilled Nursing Facility 9133026776 Practice locations: Osage Beach, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831164615. Details of each certification follow.

Skilled nursing facility certification: CCN 265429

Legal name
LAKE REGIONAL HEALTH SYSTEM
Doing business as
LAKE REGIONAL HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
May 16, 1990
Last certification
Nov 26, 2024
Beds
16
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 20, 1973 in MO
Enrollment address
54 Hospital Dr
Osage Beach, MO 65065-3050
Nursing home name
LAKE REGIONAL HEALTH SYSTEMS

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lake Regional Health SystemsCCN 265429 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
May 16, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
166.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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 disclosed owners & managing parties 22

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

NameRoleSinceShare
Dennis Michaelree Individual Managing Control - Governing BodyBoard Member Jul 1, 2019
John C Patton Individual Managing Control - Governing BodyBoard Member Jun 3, 2022
Karen K. Faiferlick Individual Managing Control - Governing BodyBoard Member Jun 3, 2022
Gregory D Anderson Individual Managing Control - Governing BodyBoard Member May 16, 1990
Kevin G McRoberts Individual Corporate OfficerCeo Jun 3, 2022
Operational/Managerial Control Jun 3, 2022
Adp of the SNF Feb 27, 2025
Charles McElyea Individual Managing Control - Governing BodyBoard Member Jun 30, 2016
Mark Rector Individual Managing Control - Governing BodyBoard Member Jun 4, 2021
Warren T Cooper Individual Managing Control - Governing BodyBoard Member - Chief of Staff Jun 6, 2024
Alan W Mead Individual Managing Control - Governing BodyBoard Member Aug 4, 2015
Paula Littleton Individual Corporate OfficerCfo Jul 22, 2024
Jason Hulett Individual Managing Control - Governing BodyBoard Member Jun 3, 2022
Patrick W Oneil Individual Operational/Managerial Control Sep 1, 2011
Adp of the SNF Feb 13, 2025
Jessica Hasty Individual Operational/Managerial Control Feb 1, 2016
Corey M Tenbensel Individual Managing Control - Governing BodyBoard Member Jun 3, 2011
Melissa Hunter Individual Corporate OfficerCno/Coo Apr 1, 2022
Larry Shields Individual Managing Control - Governing BodyBoard Member Oct 6, 1975
John Caine Individual Managing Control - Governing BodyBoard Member May 16, 1990
Kevin G Byrne Individual Managing Control - Governing BodyBoard Member Oct 1, 2004
Kristen L Prenger Individual Operational/Managerial Control Jan 1, 2024
Lake Regional Health System Organization, Osage Beach, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 23, 2006 100%
Adp of the SNF Jan 3, 2025
Direct Ownership Interest Feb 23, 2006 100%
Wayne Compton Individual Managing Control - Governing BodyBoard Member Jun 1, 2002
James D. Judas Individual Managing Control - Governing BodyBoard Member Jun 7, 2013

Owners & managing parties with NPI records 20

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

View all 20

Practitioners & affiliated clinicians

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722038400000",
    "number": "1831164615",
    "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 DRIVE",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-348-8000",
            "fax_number": "573-348-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2024-07-27",
        "certification_date": "2024-07-27",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "291-28",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "2.16.840.1.113883.17.9.1",
            "affiliation": "Y",
            "affiliationName": "Craneware, Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Fairway Dr",
            "city": "Deerfield Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334411828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.