LAKE REGIONAL HEALTH SYSTEM (NPI# 1053581454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053581454 |
| Entity Type | Organization |
| Organization Name | LAKE REGIONAL HEALTH SYSTEM |
| Practice Address |
54 Hospital Dr Osage Beach MO 65065-3050 |
| Practice Telephone | 5733488000 |
| Practice Fax Number | 5733488069 |
| Mailing Telephone | 5733488074 |
| Mailing Fax Number | 5733488069 |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2015-08-19 |
| Authorized Official Name | MR. DAVID W. HALSELL (SR. V.P., CFO/AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 5733488388 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | 291-30 | MO | Dietary & Nutritional Service Providers |
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
291-30 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 540671609 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346530797 | Lake Regional Health System | Clinic/Center | 14298 W Us Highway 54, Macks Creek, MO 65786-6730 | 2011-04-19 |
| 1427162254 | Lake Regional Health System | Clinic/Center | 156 Missouri Boulevard, Suite B, Laurie, MO 65038-4933 | 2006-08-18 |
| 1740255520 | Lake Regional Health System | Home Health | 1193 Highway Kk, Ste C, Osage Beach, MO 65065-3344 | 2006-02-23 |
| 1548743412 | Lake Regional Health System | Clinic/Center | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2018-09-07 |
| 1417492091 | Lake Regional Health System | Hospice Care, Community Based | 1193 Highway Kk, Osage Beach, MO 65065-3344 | 2017-01-05 |
| 1962828616 | Lake Regional Health System | Family Medicine | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2014-03-05 |
| 1295151959 | Lake Regional Health System | General Acute Care Hospital | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2014-03-05 |
| 1679997407 | Lake Regional Health System | Durable Medical Equipment & Medical Supplies | 54 Hospital Dr, Suite 201, Osage Beach, MO 65065-3050 | 2014-02-14 |
| 1376883843 | Lake Regional Health System | Durable Medical Equipment & Medical Supplies | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2013-02-21 |
| 1700177128 | Lake Regional Health System | Clinic/Center | 1870 Bagnell Dam Blvd, Lake Ozark, MO 65049-8658 | 2011-04-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LAKE REGIONAL HEALTH SYSTEM | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Street Address |
54 HOSPITAL DR |
| City | OSAGE BEACH |
| State | MO |
| Zip Code | 65065-3050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730184151 | Timothy D. Lischwe | Optometrist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2005-06-14 |
| 1669070298 | Kimberly Jean Farris | Nurse Practitioner | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-10-15 |
| 1437756608 | Barry Keith Hale | Physical Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-10-01 |
| 1427664614 | Samantha J Emry | Nurse Practitioner | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-09-22 |
| 1326665688 | Alyssa Heinsohn | Physical Therapist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-07-02 |
| 1255958138 | Gina Marie Fasano | Orthopaedic Surgery | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-06-26 |
| 1083230718 | Clarice Rose Schmid | Occupational Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-06-18 |
| 1093338857 | James Daniel Calkins | Physical Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-05-27 |
| 1205476934 | Krystin Nicole Hall | Speech-Language Pathologist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-01-10 |
| 1144868209 | Kristen Kay Lee | Speech-Language Pathologist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2019-12-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437778859 | Suzanne Marie Harris | Social Worker | 1191 State Highway Kk, Suite 101, Osage Beach, MO 65065 | 2020-04-15 |
| 1982172342 | Arrowhead Retirement Operations LLC | Skilled Nursing Facility | 6100 Arrowhead Drive, Osage Beach, MO 65065 | 2018-11-05 |
| 1245723337 | William T Mcfail | Counselor | 1191 State Hwy Kk, Suite 101, Osage Beach, MO 65065 | 2018-06-13 |
| 1588102263 | Jennifer Kiske | Physical Therapist | 5780 Osage Beach Parkway, Ste 220, Osage Beach, MO 65065 | 2017-02-02 |
| 1700207586 | Brenda Renee Spies | Pharmacist | 4252 Osage Beach Parkway, Osage Beach, MO 65065 | 2013-12-23 |
| 1154668465 | Paige Hedgpath Od, PC | Optometrist | 4645g Osage Beach Parkway, Osage Beach, MO 65065 | 2013-01-07 |
| 1649548330 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 300 Kestrel Lane, Lake Ozark, MO 65065 | 2011-12-08 |
| 1437399821 | Melissa Nicole Morgan | Physical Therapy Assistant | 5177 Vicus Castri, Osage Beach, MO 65065 | 2009-02-25 |
| 1730330911 | Raymond Don Baker | Preventive Medicine | 5476 Stone Ledge Cir, Osage Beach, MO 65065 | 2008-10-06 |
| 1457514259 | Lake Family Dentistry | Dentist | 1037 Palisades Blvd Ste 9, Osage Beach, MO 65065 | 2008-07-02 |
| Find all providers in zip 65065 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134215759 | Guy R Kline | Emergency Medicine | 6141 Oak Creek Dr, Osage Beach, MO 65065-2571 | 2006-10-04 |
| 1861585424 | Robert D King | Emergency Medicine | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2006-10-02 |
| 1073606695 | John M Loney | Emergency Medicine | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2006-10-02 |
| 1487757142 | Robert W. Hyatt | Emergency Medicine | 54 Hospital Drive, Osage Beach, MO 65065-3050 | 2006-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962777557 | Blue Springs Emergency Physician Services PC | Emergency Medicine | 201 Nw Rd Mize Road, Blue Springs, MO 64014 | 2012-03-14 |
| 1225160179 | William F Bowman | Emergency Medicine | Heartland Regional Medical Center, 5325 Faraon St, St. Joseph, MO 64506 | 2007-03-09 |
| 1750434999 | Luis Robles | Emergency Medicine | 529 Southwest Blvd, Kansas City, MO 64108-2122 | 2007-01-19 |
| 1053413542 | Michael Eligio Fritsche | Emergency Medicine | 625 Bemis Heights Pl, Saint Charles, MO 63303-1752 | 2006-09-04 |
| 1144251679 | Akeeb Adedokun | Emergency Medicine | 5058 Romaine Spring Dr, Fenton, MO 63026-5868 | 2006-07-05 |
| 1598700684 | Raana J Ponstingl | Emergency Medicine | 3635 Vista At Grand Boulevard, Saint Louis, MO 63110 | 2006-06-20 |
| 1740264670 | Pamela Westerling | Emergency Medicine | 230 Tompkins Court, Troy, MO 63379 | 2005-12-05 |
| 1104432640 | Complex Healthcare of Des Peres LLC | Emergency Medicine | 1032 Old Des Peres Rd, Saint Louis, MO 63131-1865 | 2020-09-21 |
| 1003337858 | William Kells Boland | Emergency Medicine | 1 Barnes-jewish Hospital Plaza, St. Louis, MO 63110 | 2017-07-02 |
| 1154703841 | Preston Mangum Gilbert | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2015-06-18 |
| Find all providers with the same taxonomy | ||||
| City | OSAGE BEACH |
| Zip Code | 65065 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.