NPIMap

Organization Active NPI

Mayo Clinic Health System-Lake City

  • Medicare Defined Swing Bed Hospital Unit
  • Lake City, MN
National Provider Identifier
1891710893
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
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
Jul 12, 2006
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

500 W Grant St
Lake City, MN 55041-1143

Mailing address

500 W Grant St
Lake City, MN 55041-1143
Phone (651) 345-3321

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070711000290 MN Part A Provider - Critical Access Hospital 1951213487 Practice locations: Lake City, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891710893. Details of each certification follow.

Hospital certification: CCN 24Z338

Legal name
MAYO CLINIC HEALTH SYSTEM-LAKE CITY
Organization structure
CorporationNon-profit
Incorporated
Apr 28, 1998 in MN
Enrollment address
500 W Grant St
Lake City, MN 55041-1143
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Mayo Clinic Health System-Lake City4 organizations share this tax ID, including this one
Part of
Mayo Clinic Health System-Lake City

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Taryn Schruth Individual Corporate OfficerSecretary Nov 13, 2025
Randy M Foss Individual Corporate OfficerCeo/President/Chair Jan 1, 2024
Corporate DirectorBoard Member Jan 1, 2017
Megan Kramer Individual Corporate DirectorBoard Member Feb 1, 2026
Kathleen Durand Individual Corporate DirectorBoard Member Jul 1, 2023
Karthik Ghosh Individual Corporate OfficerVice Chair Nov 13, 2025
Joshua Smith Individual Corporate DirectorBoard Member Jan 1, 2022
Travis Paul Individual Corporate OfficerChief Administrative Officer Jan 1, 2025
Mayo Clinic Health System-Southeast Minnesota Region Organization, Albert Lea, MN Corporation, Non-profit, Chain home office Operational/Managerial Control Jan 1, 2019
Christopher R Gulden Individual W-2 Managing EmployeeAd; Jan 1, 2025
Mayo Clinic Organization, Rochester, MN Corporation, Non-profit Operational/Managerial Control Mar 16, 2007
Bethanie Flattum Individual Corporate OfficerTreasurer & Vice Chair Jan 1, 2021
Katie E Hinderaker Individual Corporate DirectorBoard Member Jul 10, 2025
Trent Anderson Individual Corporate DirectorBoard Member Jan 1, 2025
Tracy Sexton Oliver Individual Corporate DirectorBoard Member Jan 1, 2018
Morris Miller Individual Corporate OfficerChief Financial Officer Jul 1, 2023

Owners & managing parties with NPI records 18

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

View all 18

Facilities with the same owner 38

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

View all 38

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1891710893",
    "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": "2006-07-12",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": []
}

Other providers in Lake City, MN

Sources for this page

Verify at the official NPI Registry.