Lakewood Health Center
Organization Active NPI Critical Access Hospital · Baudette, MN
NPI 1922072776 · NPPES record last updated Feb 27, 2020
Key facts
- NPI
- 1922072776
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 331065 (MN)
- Legal business name
- LAKEWOOD HEALTH CENTER
- Practice address
- 600 Main Ave S
Baudette, MN 56623-2855 - Phone
- (218) 634-2120
- Fax
- (218) 634-1016
- NPI assigned
- Feb 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeffry A Stampohar
- Title
- President
- Phone
- (218) 634-2120
Owners & managing parties with NPI records 1
-
Justin Quo, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 2
Practitioners 35
-
Gina Ann Lablanc, CNP
-
Morgan Marie Longtin, FNP-C
-
Justin Quo, M.D.
-
Jerry Russell Bartleson, M.D.
-
Sheila Diane Bullock, FNP-C
-
Fahd Arafat, MD
-
Sarah J Gubbels, LICSW
-
Daniel J Margo, M.D.
-
Amy Renee Moser, PMHNP
-
Jordan James Reese, CNP
-
Wade Robert Sendelbach, MSN, APRN, CNP
-
Michael J Clark, DO
-
Audrey Jean Marjama, FNP
-
Rachael Faye Pickett Theel, FNP-C
-
Anna Stein, PSY.D., LP
Affiliated clinicians 41
-
Fahd Arafat, MD
-
Mark Joel Carlson, M.D.
-
Daniel Lee Courneya, M.D.
-
Billie Jo Dressing, NP-C
-
Jonathan Ross Fish, M.D.
-
Marianne Renae Foldesi, PA-C
-
Joseph P Koury, M.D.
-
Gina Ann Lablanc, CNP
-
Lacey Ann Langerak, PAC
-
Morgan Marie Longtin, FNP-C
-
Ashley Marie Lundin, M.D.
-
Mouhamad Mansour, M.D.
-
Daniel J Margo, M.D.
-
Matthew Albert McGee, PA-C
-
Amy Renee Moser, PMHNP
-
Matthew John Nielsen, M.D.
-
Lee Richard Potratz, PA-C, ATC
-
Kelly D Pruett, APN
Medicare Care Compare: Hospital
- Listed as
- Lakewood Health Center
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Church
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Hospital certification: CCN 241301
- Legal name
- LAKEWOOD HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jul 29, 1999
- Last certification
- Aug 13, 2025
- Beds
- 15
- Ownership / control type
- Church
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 9, 1956 in MN
- Enrollment address
- 600 Main Ave S
Baudette, MN 56623-2855
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Commonspirit Health |
5% Or Greater Direct Ownership Interest | Jul 1, 1996 | 100% |
| Jeffry a Stampohar |
Corporate Officer |
Jan 15, 2018 | |
| W-2 Managing Employee |
Jan 15, 2018 | ||
| Lloyd H Dean |
Corporate Officer |
Jun 1, 2000 | |
| Bradley Nylander |
Corporate Director |
May 1, 2017 | |
| Amber G Stowman |
Corporate Officer |
Aug 12, 2018 | |
| Jay Paul Ross |
Corporate Officer | Jul 1, 2015 | |
| W-2 Managing Employee | Jul 1, 2015 | ||
| James Austad |
Corporate Director |
Jul 1, 2019 | |
| Bruce Burton |
Corporate Director |
Jan 1, 2014 | |
| Brent J Schmidt |
Corporate Officer |
Jul 1, 2015 | |
| W-2 Managing Employee |
Jul 1, 2015 | ||
| Bernice M Ebner |
Corporate Director |
Jul 1, 2019 | |
| Justin Quo |
Corporate Director |
Jan 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031104000469 | MN | Part B Supplier - Clinic/Group Practice | 5698687929 |
Receives reassigned benefits from 27 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Baudette, MN |
| O20080118000179 | MN | Part a Provider - Critical Access Hospital | 5698687929 |
Receives reassigned benefits from 30 practitioners Practice locations: Baudette, MN |
National Provider Directory
Locations
806 Main St W
Baudette, MN 56623
Phone (218) 634-1795
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 331065 | MN | Yes |
Addresses
Primary practice location
600 Main Ave S
Baudette, MN 56623-2855
Mailing address
600 Main Ave S
Baudette, MN 56623-2855
Phone (218) 634-2120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1535HTR | Other | MN | BLUE CROSS OF MINNESOTA |
| 199245700 | Medicaid | MN |
Other names
- CHI Lakewood Health
Other providers in Baudette, MN
- Lakewood Health Center
- Lakewood Health Center
- Lakewood Health Center
- Lakewood Health Center
- Lakewood Health Center
- Lakewood Health Center
- Morgan Marie Longtin
- Matthew Albert McGee
- Christopher Kelley McGraw
- Gabriel Dan Mooney
All providers in Baudette, MN · Critical Access Hospital in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.