Active NPI
Mount Carmel Home Keens Memorial
- Skilled Nursing Facility
- Kearney, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 074003
- Legal business name
- MOUNT CARMEL HOME KEENS MEMORIAL
- Practice address
- 412 W 18TH St
Kearney, NE 68845-5948 - Phone
- (308) 237-2287
- Fax
- (308) 237-7264
- NPI assigned
- Apr 12, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tracy Banda
- Title
- Director of Operations
- Phone
- (308) 237-2287
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 074003 | NE | Primary |
Addresses
Primary practice location
412 W 18TH St
Kearney, NE 68845-5948
Mailing address
412 W 18TH St
Kearney, NE 68845-5948
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00661 | Other | NE | BLUE CROSS BLUE SHIELD |
Other names 3
- Mount Carmel Home- Keens Memorial
- Mt Carmel Home
- Mt Carmel Home- Keens Memorial
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030327000005 | NE | Part A Provider - Skilled Nursing Facility | 7517876741 | Practice locations: Kearney, NE |
Skilled nursing facility certification: CCN 285216
- Legal name
- MOUNT CARMEL HOME KEENS MEMORIAL
- Doing business as
- MT CARMEL HOME - KEENS MEMORIAL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 1, 1997
- Last certification
- Nov 13, 2024
- Beds
- 75
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Other
- Enrollment address
- 412 W 18TH St
Kearney, NE 68845-5948 - Nursing home name
- MT CARMEL HOME - KEENS MEMORIAL
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Mt Carmel Home - Keens Memorial
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Dec 1, 1997
- Medicare certification status
- Active
- Certified beds
- 75
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0455958 | Mount Carmel Home | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Katherine Johnson | Corporate Director | Jul 9, 2017 | |
| Adp of the SNF | Jan 8, 2025 | ||
| Robert C Messbarger | Contracted Managing Employee | Oct 1, 2020 | 100% |
| Adp of the SNF | Jan 8, 2025 | ||
| Mary Therese Blavet | 5% Or Greater Direct Ownership Interest | Jan 1, 2016 | 100% |
| Corporate Officer | Aug 1, 2013 | ||
| Other | Oct 31, 2014 | ||
| Adp of the SNF | Jan 8, 2025 | ||
| Direct Ownership Interest | Jan 1, 2016 | 4.9% | |
| Tracy Banda | Corporate Officer | Jan 1, 2016 | 100% |
| W-2 Managing Employee | Feb 28, 2006 | 100% | |
| Operational/Managerial Control | Jan 1, 2016 | 100% | |
| Emily Birdsley | Contracted Managing Employee | Aug 7, 2018 | |
| Corporate Officer | Feb 4, 2018 | ||
| Adp of the SNF | Jan 8, 2025 | ||
| Katrina Charles | Other | Oct 31, 2014 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Kearney, NE
- NPI 1407883705
Adp of the SNF, Contracted Managing Employee
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Kearney, NE
- NPI 1407883705
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1656028800000",
"number": "1073577680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 W 18TH ST",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688455948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 W 18TH ST",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688455948",
"telephone_number": "308-237-2287",
"fax_number": "308-237-7264"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOUNT CARMEL HOME KEENS MEMORIAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-12",
"last_updated": "2022-06-24",
"certification_date": "2022-06-24",
"status": "A",
"authorized_official_last_name": "BANDA",
"authorized_official_first_name": "TRACY",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "308-237-2287"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NE",
"license": "074003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "00661",
"state": "NE"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mount Carmel Home- Keens Memorial",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mt Carmel Home",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mt Carmel Home- Keens Memorial",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.