Bloomfield Medical Clinic, PC

Key facts

NPI: 1003091497
Entity type: Organization (NPI type 2)
Primary specialty: Medical Physician Assistant 363AM0700X
License: 1040 (NE)
Legal business name: BLOOMFIELD MEDICAL CLINIC, PC
Practice address: 105 S Broadway Avenue
Bloomfield, NE 68718-0357
Phone: (402) 373-4341
Fax: (402) 373-4344
NPI assigned: Jan 3, 2008
Organization subpart: No

Authorized official

Name: Kevin D Lauck, PA-C NPI 1598713885
Title: President
Phone: (402) 373-4341

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Bloomfield Medical Clinic Family Medicine Physician · Osmond, NE · NPI 1902355951

NPPES parent name

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Kevin D. Lauck, PA-C Physician Assistant · Bloomfield, NE · NPI 1598713885

Medicare reassignment Care Compare group Authorized official NE
Christopher Burrell, FNP-C Family Nurse Practitioner · Creighton, NE · NPI 1518740844

Medicare reassignment Care Compare group NPD FAMILY · NE
Riley Glee Eckmann, MD Family Medicine Physician · Bloomfield, NE · NPI 1447487129

Medicare reassignment Care Compare group NPD NE
Angela Blane Chambers, PA-C Medical Physician Assistant · Omaha, NE · NPI 1790972719

Medicare reassignment Care Compare group NE

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
28D0455576	Bloomfield Medical Clinic PC 105 South Broadway, Bloomfield, NE 68718	Compliance	Aug 18, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NE

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20080129000530	NE	Part B Supplier - Clinic/Group Practice	5890877831	Receives reassigned benefits from 4 practitioners Practice locations: Wausa, NE; Verdigre, NE; Plainview, NE; Pierce, NE; Osmond, NE; Hartington, NE; Creighton, NE; Bloomfield, NE

National Provider Directory

Locations

301 N 2ND St
Bloomfield, NE 68718
Phone (402) 373-2531

415 Barnwell Ave NW
Aiken, SC 29801
Phone (803) 226-0274

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medical Physician Assistant Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	363AM0700X	1040	NE	Yes
Family Nurse Practitioner Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	363LF0000X	110153	NE

Addresses

Primary practice location

105 S Broadway Avenue
Bloomfield, NE 68718-0357

Mailing address

105 S Broadway Avenue
P O Box 357
Bloomfield, NE 68718-0357
Phone (402) 373-4341

Other identifiers

Identifier	Type	State	Issuer
10025588500	Medicaid	NE

Other providers in Bloomfield, NE

All providers in Bloomfield, NE · Medical Physician Assistant in Nebraska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2010. 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.
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.

Verify at the official NPI Registry.