NPIMap

Organization Active NPI

Lakewood Health System

  • Community Based Hospice Care Agency
  • Staples, MN
National Provider Identifier
1922099092
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
376567 Issued in MN
Legal business name
LAKEWOOD HEALTH SYSTEM
Practice address
401 Prairie Ave NE
Staples, MN 56479-3201
Phone
(218) 894-1515
Fax
(218) 898-7596
NPI assigned
Oct 28, 2005
Last updated
Jun 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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

Authorized official

Name
Joseph T Reycraft
Title
Cfo
Phone
(218) 894-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 376567 MN Primary

Addresses

Primary practice location

401 Prairie Ave NE
Staples, MN 56479-3201

Mailing address

401 Prairie Ave NE
Staples, MN 56479-3201
Phone (218) 894-1515

Other names 1

  • Lakewood Health System Hospice Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090729000113 MN Part A Provider - Hospice 1052229671 Practice locations: Staples, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922099092. Details of each certification follow.

Hospice certification: CCN 241559

Legal name
LAKEWOOD HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 6, 1996
Last certification
Jun 30, 2022
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1997 in MN
Enrollment address
401 Prairie Ave NE
Staples, MN 56479-3201

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Care Compare: Hospice

Medicare Care Compare
Listed as
Lakewood Health System HospiceCCN 241559 · All quality measures
Ownership
Non-Profit
Certified
Aug 6, 1996
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Lakewood Clinic Staples14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 34

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

NameRoleSinceShare
Melissa Beth Lindow Individual Operational/Managerial ControlChief Operating Officer Aug 27, 2023
Billy Joe Haehnel Individual Corporate Director Nov 1, 2015
Joseph Thomas Reycraft Individual Corporate OfficerCfo Aug 28, 2022
Operational/Managerial ControlCfo Aug 28, 2022
Curtis Eugene McIlravy Individual Corporate OfficerSystem Board Chair Jul 1, 2014
Corporate DirectorSystem Board Chair Jul 1, 2014
Ryan David Kray Individual Corporate DirectorMember Oct 1, 2021
Robert Michael Mueller Individual Corporate OfficerDistrict Vice Chair Jun 25, 2015
Corporate DirectorDistrict Vice Chair Jun 25, 2015
Sara Jane Grove Individual Corporate Director Apr 24, 2014
Craig Thomas Wolhowe Individual Corporate OfficerVP of Clinics & Medical Providers Jun 11, 1997
Operational/Managerial ControlVP of Clinics & Medical Providers Jun 11, 1997
Alicia Kay Bauman Individual Operational/Managerial ControlChief Talent Officer Oct 9, 2022
Mary Martha Theurer Individual Corporate DirectorDistrict Chair/System Secretary Jan 1, 2010
Elizabeth Ann Pottratz Individual Corporate DirectorBoard Member Jan 1, 2023
Lisa Marie Bjerga Individual Corporate OfficerCeo/President Sep 1, 2022
Operational/Managerial ControlCeo/President Mar 7, 2016
Kaitlyn Rose Schoeck Individual Corporate DirectorMember Aug 7, 2017
Lana Ellen Hansen Individual Corporate DirectorDistrict Secretary Jan 1, 2008
Ronald Alvin Storbakken Individual Corporate Director Jan 1, 2000
Franz Harry Achermann Individual Corporate DirectorBoard Member Jan 1, 2025
Kathleen Marie Dobson Individual Operational/Managerial ControlVP of Senior Services Feb 1, 2014
James Alan Roeder Individual Operational/Managerial ControlVP of Information Technology Jan 1, 2018
Mary Ann Fitcher Individual Corporate DirectorBoard Member Jan 1, 2025
Brad Richard Anderson Individual Operational/Managerial ControlChief Development Officer Aug 13, 2014
Amy Jo Brichacek Individual Corporate DirectorMember Jan 1, 2021
Emil Paul Wicht Individual Corporate Director Jan 1, 1973
Melissa Sue Daniels Individual W-2 Managing EmployeeExecutive Assistant to Cfo Sep 15, 2016
Michael Lee Austin Individual Operational/Managerial ControlVP of Clinic Services Dec 30, 2024
Norman Harold Krause Individual Corporate DirectorMember Jul 1, 2018
Daniel John Douts Individual Corporate DirectorBoard Member May 1, 2024
Susan Kay Peet Individual Corporate DirectorDistrict Treasurer Jan 1, 2021
Wade Thomas Swenson Individual Corporate DirectorBoard Member Jan 1, 2023
Lindsay Rae Leveille Individual Corporate DirectorBoard Member Jul 1, 2023
Christine Sara Albrecht Individual Corporate Director Jun 30, 2009
Sarah Ann Jennissen Individual Corporate DirectorBoard Member Jul 1, 2024
Beverly Jean Hoemberg Individual Corporate Director Jan 1, 2011
Jef Richard Cichos Individual Corporate DirectorSystem Vice Chair Jul 1, 2016
Sarah Jane Baumgartner Individual Operational/Managerial ControlVP of Nursing Jul 1, 2024

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Lakewood ClinicStaples, MN, CCN 243422 Rural health clinic 5% Or Greater Direct Ownership Interest
General Partnership Interest		 Apr 1, 1997
Apr 1, 1997
Lakewood Clinic-BrowervilleEagle Bend, MN, CCN 243421 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1997
Lakewood Clinic-PillagerPillager, MN, CCN 243436 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Mar 1, 1998
Mar 1, 1998

Owned or controlled facilities with NPI records 3

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

  • Lakewood Health System

    dba Lakewood Clinic Eagle Bend

    • Rural Health Clinic/Center
    • Eagle Bend, MN
    • NPI 1093706160

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Lakewood Health System

    dba Lakewood Clinic Pillager

    • Rural Health Clinic/Center
    • Pillager, MN
    • NPI 1811988983

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Lakewood Health System

    dba Lakewood Clinic Staples

    • Rural Health Clinic/Center
    • Staples, MN
    • NPI 1841280823

    5% Or Greater Direct Ownership Interest, General Partnership Interest

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1922099092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 PRAIRIE AVE NE",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564793201",
            "telephone_number": "218-894-1515",
            "fax_number": "218-898-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PRAIRIE AVE NE",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564793201",
            "telephone_number": "218-894-1515",
            "fax_number": "218-898-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "REYCRAFT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-894-8194"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "376567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Health System Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Staples, MN

Sources for this page

Verify at the official NPI Registry.