{"npi":"1093713372","type":"NPI-2","status":"active","name":{"display":"Lake Region Healthcare Corporation","other":[],"organization_name":"LAKE REGION HEALTHCARE CORPORATION","authorised_official":"Kent Mattson"},"specialty":{"primary_taxonomy":"282N00000X","primary_taxonomy_description":"General Acute Care Hospital","slug":"general-acute-care-hospital","schema_org_specialty":null,"all":[{"code":"282N00000X","description":"General Acute Care Hospital","primary":true,"state":"MN","license":"327293"}]},"addresses":[{"purpose":"LOCATION","street_1":"712 S CASCADE ST","city":"FERGUS FALLS","state":"MN","postal_code":"565372913","country_code":"US","phone":"2187368000","fax":"2187368775"},{"purpose":"MAILING","street_1":"712 S CASCADE ST","city":"FERGUS FALLS","state":"MN","postal_code":"565372913","country_code":"US","phone":"2187368000","fax":"2187368775"}],"license":{"state":"MN","number":"327293"},"identifiers":[{"type_code":"01","label":"Other","value":"1637HLA","state":"MN","issuer":"BLUE CROSS"},{"type_code":"05","label":"Medicaid","value":"316714300","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"510847101","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"510847167","state":"MN","issuer":null},{"type_code":"01","label":"Other","value":"1637ELA","state":"MN","issuer":"BLUE CROSS"},{"type_code":"01","label":"Other","value":"60685LA","state":"MN","issuer":"BLUE CROSS"},{"type_code":"05","label":"Medicaid","value":"510847100","state":"MN","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20060109000246","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MN","pac_id":"3971565334"},{"enrlmt_id":"O20170804001236","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"ND","pac_id":"3971565334"},{"enrlmt_id":"O20210503000826","type_code":"53-D1","type_desc":"MDPP SUPPLIER - IN-PERSON MDPP SUPPLIER","state":"MN","pac_id":"3971565334"}]},"enumeration_date":"2005-07-12","last_updated":"2024-08-19","_meta":{"source":"NPPES","snapshot_date":"2024-08-19","doc_url":"https://findmynpi.com/api"}}