NPIMap

Organization Active NPI

Memorial Community Health, Inc

Doing business as Memorial Hospital

  • Critical Access Hospital
  • Aurora, NE
National Provider Identifier
1063429694
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
380001 Issued in NE
Legal business name
MEMORIAL COMMUNITY HEALTH, INC
Doing business as
Memorial Hospital
Practice address
1423 7TH St
Aurora, NE 68818-1141
Phone
(402) 694-3171
Fax
(402) 694-5024
NPI assigned
Aug 3, 2006
Last updated
Dec 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

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

Authorized official

Name
Mr. Phil James Fendt
Title
Cfo
Phone
(402) 694-8204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 380001 NE Primary

Addresses

Primary practice location

1423 7TH St
Aurora, NE 68818-1141

Mailing address

1423 7TH St
Aurora, NE 68818-1141
Phone (402) 694-3171

Other names 1

  • MEMORIAL HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070312000147 NE Part A Provider - Critical Access Hospital 1355394040 Receives reassigned benefits from 17 practitioners
Practice locations: Aurora, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063429694. Details of each certification follow.

Hospital certification: CCN 281320

Legal name
MEMORIAL COMMUNITY HEALTH INC
Doing business as
MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2000
Last certification
Aug 24, 2023
Beds
12
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1423 7TH St
Aurora, NE 68818-1141
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HospitalCCN 281320 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/a4c7307b-5132-41db-ae59-8b3c5b480948/
  • Direct secure messaging: inpatientdirect@mchi.cernerdirect.com

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Bradley Bish Individual Corporate DirectorDirector Jul 1, 2010
Cody Hoegh Individual Corporate DirectorDirector May 1, 2020
Chad Garrett Individual Corporate DirectorDirector Mar 1, 2020
Wayne Hahn Individual Corporate DirectorDirector Sep 1, 2014
Kenneth Spray Individual Corporate DirectorDirector Apr 1, 2018
Jayne Smith Individual Corporate DirectorTreasurer Oct 26, 2004
Harlan Schafer Individual Corporate DirectorDirector May 1, 2018
Justin Wolf Individual Corporate OfficerCeo Jun 27, 2022
W-2 Managing EmployeeCeo Jun 27, 2022 100%
Dennis Ferguson Individual Corporate DirectorPresident Jan 10, 2008
Michael McQuiston Individual Corporate Director Mar 1, 2024
Jennie Akerlund-Kuehner Individual Corporate DirectorSecretary Sep 1, 2012
Roger Scott Individual Corporate DirectorDirector May 1, 2009
Pamela Riley Individual Corporate DirectorDirector Apr 1, 2019
Jason Schneider Individual Corporate DirectorVice President Jan 10, 2008
Mark Klute Individual Corporate DirectorDirector Apr 1, 2014
Phil Fendt Individual Corporate OfficerCfo Jul 15, 2002
W-2 Managing EmployeeCfo Jul 15, 1992
Deborah Dawn Nelson Individual Corporate Director Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

Affiliated clinicians 83

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 83

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262131200000",
    "number": "1063429694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 7TH ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181141",
            "telephone_number": "402-694-3171",
            "fax_number": "402-694-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 7TH ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181141",
            "telephone_number": "402-694-3171",
            "fax_number": "402-694-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL COMMUNITY HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2009-12-30",
        "status": "A",
        "authorized_official_last_name": "FENDT",
        "authorized_official_first_name": "PHIL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "402-694-8204",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NE",
            "license": "380001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, NE

Sources for this page

Verify at the official NPI Registry.