| Lake Regional Medical Group | |
|
54 Hospital Dr Osage Beach MO 65065-3050 | |
| (573) 348-8074 | |
| (573) 348-8069 |
| Full Name | Lake Regional Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 54 Hospital Dr, Osage Beach, Missouri |
| Authorized Official Name and Position | Kevin Mcroberts (CEO) |
| Authorized Official Contact | 5733488756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Regional Medical Group Po Box 801661 Kansas City MO 64180-1661 Ph: (573) 348-8000 | Lake Regional Medical Group 54 Hospital Dr Osage Beach MO 65065-3050 Ph: (573) 348-8074 |
| NPI Number | 1639134158 |
|---|---|
| Provider Enumeration Date | 04/18/2006 |
| Last Update Date | 11/04/2024 |
| Medicare PECOS PAC ID | 3577467323 |
|---|---|
| Medicare Enrollment ID | O20031122000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639134158 | NPI | - | NPPES |
| 501945604 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Zubair A Khan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861491854 PECOS PAC ID: 8729982582 Enrollment ID: I20031122000106 |
| Provider Name | Miriam B Borden |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1518966571 PECOS PAC ID: 2961463112 Enrollment ID: I20041021000642 |
| Provider Name | Randy G Brown |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1134218662 PECOS PAC ID: 0042268112 Enrollment ID: I20050316000169 |
| Provider Name | Jeffrey M Jones |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1942296314 PECOS PAC ID: 7416845524 Enrollment ID: I20050818000005 |
| Provider Name | Muthu S Krishnan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528089539 PECOS PAC ID: 8123048535 Enrollment ID: I20051130000636 |
| Provider Name | Trevor Axford |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1528094224 PECOS PAC ID: 0648274449 Enrollment ID: I20060911000212 |
| Provider Name | Curtis D Mather |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1053414524 PECOS PAC ID: 8729056593 Enrollment ID: I20061103000266 |
| Provider Name | Jeffrey J Mutchler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1205946449 PECOS PAC ID: 2365449386 Enrollment ID: I20061103000326 |
| Provider Name | John C Patton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194737346 PECOS PAC ID: 1456353424 Enrollment ID: I20070203000075 |
| Provider Name | Kevin G Byrne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326020082 PECOS PAC ID: 8224139407 Enrollment ID: I20070719000049 |
| Provider Name | Justin A Malone |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689895534 PECOS PAC ID: 6406948439 Enrollment ID: I20070822001247 |
| Provider Name | Harjyot S Sohal |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1962468520 PECOS PAC ID: 2860564465 Enrollment ID: I20080626000163 |
| Provider Name | Lisa G Kolb |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1336135276 PECOS PAC ID: 2567552912 Enrollment ID: I20080805000627 |
| Provider Name | Jerrold Allan Schermer |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1851305916 PECOS PAC ID: 9335141472 Enrollment ID: I20100619000162 |
| Provider Name | Donald R Thompson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467520346 PECOS PAC ID: 7113059346 Enrollment ID: I20100722000997 |
| Provider Name | Michael S Severance |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1790708907 PECOS PAC ID: 3678539707 Enrollment ID: I20100820000479 |
| Provider Name | Philip J Kurle |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184692568 PECOS PAC ID: 8426047911 Enrollment ID: I20100924001351 |
| Provider Name | Patience R Mccoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417116187 PECOS PAC ID: 1153518089 Enrollment ID: I20101204000110 |
| Provider Name | Cody L Fox |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1366768939 PECOS PAC ID: 2466632054 Enrollment ID: I20110215000315 |
| Provider Name | Harbaksh Singh Sangha |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1629170741 PECOS PAC ID: 7214118785 Enrollment ID: I20110217000202 |
| Provider Name | Keith A Bonacquisti |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1487773669 PECOS PAC ID: 1153339825 Enrollment ID: I20120104000462 |
| Provider Name | Justin T Shatto |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518187467 PECOS PAC ID: 4082862289 Enrollment ID: I20120913000072 |
| Provider Name | Scott L Hofer |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285614354 PECOS PAC ID: 2860403078 Enrollment ID: I20121017000691 |
| Provider Name | Tania B Beltran-papsdorf |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053571760 PECOS PAC ID: 0446401806 Enrollment ID: I20130716000548 |
| Provider Name | Jacob A Quick |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1649431941 PECOS PAC ID: 8022242445 Enrollment ID: I20140522001567 |
| Provider Name | Hariharan Regunath |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1851603617 PECOS PAC ID: 1658507504 Enrollment ID: I20150216000663 |
| Provider Name | Teresa Buol |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780787937 PECOS PAC ID: 1951614916 Enrollment ID: I20150720002167 |
| Provider Name | Alicia Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821469537 PECOS PAC ID: 4688983224 Enrollment ID: I20151021001649 |
| Provider Name | Eric Mcqueary |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1609215003 PECOS PAC ID: 2466756671 Enrollment ID: I20180621000047 |
| Provider Name | Eric R Varboncouer |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164643201 PECOS PAC ID: 4385817162 Enrollment ID: I20181019001923 |
| Provider Name | Hailey Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083249213 PECOS PAC ID: 9739510660 Enrollment ID: I20200511000206 |
| Provider Name | Samantha J Emry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427664614 PECOS PAC ID: 8820409444 Enrollment ID: I20201202002243 |
| Provider Name | Oluwakunle Oluwatosin |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1396912796 PECOS PAC ID: 1557439262 Enrollment ID: I20201207000637 |
| Provider Name | Jeffrey Anglen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1922050400 PECOS PAC ID: 0244280139 Enrollment ID: I20210108000803 |
| Provider Name | Stephanie L Tittle |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1306415971 PECOS PAC ID: 7618379645 Enrollment ID: I20210713001440 |
| Provider Name | Chelsea Megan Pendleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427663863 PECOS PAC ID: 6800292954 Enrollment ID: I20210915000935 |
| Provider Name | Jessica L Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326704297 PECOS PAC ID: 0941691133 Enrollment ID: I20211223000296 |
| Provider Name | Lyndsay D Funke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164177069 PECOS PAC ID: 6507253721 Enrollment ID: I20220418001863 |
| Provider Name | Eddie Tang |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1093729691 PECOS PAC ID: 3870562267 Enrollment ID: I20220826001196 |
| Provider Name | Teresa Lynne Bauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295446706 PECOS PAC ID: 2961875315 Enrollment ID: I20230306000727 |
| Provider Name | Jennifer Buckingham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447950878 PECOS PAC ID: 6507231875 Enrollment ID: I20230419001006 |
| Provider Name | Hallie Jean Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154107654 PECOS PAC ID: 9638526478 Enrollment ID: I20231115002900 |
| Provider Name | Taylor Lyn Rizer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740057249 PECOS PAC ID: 6002253911 Enrollment ID: I20240327000207 |
| Provider Name | Kayla Colleen Reeves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285496125 PECOS PAC ID: 3476991514 Enrollment ID: I20240409001137 |
The Lake's Liver And Digestive Health Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1029 Nichols Rd Ste 201, Osage Beach, MO 65065 Phone: 573-302-7138 Fax: 573-302-4686 | |
Osage Family Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1191 Highway Kk, Suite 202, Osage Beach, MO 65065 Phone: 573-302-0670 Fax: 573-302-0677 | |
Lake Regional Clinic - Osage Beach Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1057 Medical Park Dr, Suite A, Osage Beach, MO 65065 Phone: 573-302-3100 Fax: 573-348-8279 | |
Lake Regional Health System Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-348-8000 | |
Lake Regional Obstetrics & Gynecology Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 54 Hospital Dr Ste 201, Osage Beach, MO 65065 Phone: 573-302-2764 Fax: 573-302-2767 | |
Jcmg At The Lake Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5816 Osage Beach Pkwy Ste 105, Osage Beach, MO 65065 Phone: 573-348-3001 Fax: 573-348-5998 |