NPIMap

Organization Active NPI

Alegent Health Memorial Hospital, Schuyler

Doing business as CHI Health Clinic Clarkson

  • Rural Health Clinic/Center
  • Clarkson, NE
National Provider Identifier
1093890576
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER
Doing business as
CHI Health Clinic Clarkson
Practice address
322 Pine St
Clarkson, NE 68629-4094
Phone
(402) 892-3466
Fax
(402) 892-3113
NPI assigned
Oct 25, 2006
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Evert Kuiper
Title
Ceo - CHI Health
Phone
(402) 343-4671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

322 Pine St
Clarkson, NE 68629-4094

Mailing address

322 Pine St
Clarkson, NE 68629-4094
Phone (402) 892-3466

Other names 1

  • CHI Health Clinic Clarkson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100513000534 NE Part A Provider - Rural Health Clinic 6406765965 Practice locations: Clarkson, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093890576. Details of each certification follow.

Rural health clinic certification: CCN 283461

Legal name
ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER
Doing business as
CHI HEALTH CLINIC CLARKSON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2003
Last certification
May 17, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1950 in NE
Enrollment address
322 Pine St
Clarkson, NE 68629-4094
Related CCNs
281323

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

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0455416CHI Health Clinic Clarkson322 Pine Street, Clarkson, NE 68629Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Schuyler Medical Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

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
CHI Nebraska Organization, Omaha, NE Corporation 5% Or Greater Direct Ownership Interest Aug 1, 2013 100%
Marvin O'Quinn Individual OtherCSH Home Office Administrator Aug 1, 2022
Nadine a Heimann Individual Corporate Director Jul 1, 2019
Maurita Soukup Individual Corporate Director Jul 1, 2017
Commonspirit Health Organization, Englewood, CO Corporation 5% Or Greater Indirect Ownership Interest Aug 1, 2013 100%
William Barney Individual Corporate Director Jul 1, 2020
Kevin Fitzgerald Individual Corporate DirectorBod Jul 15, 2021
Suzanne L Hruza Individual Corporate Director Sep 18, 2014
Nick O'Tool Individual Operational/Managerial ControlInterim Cfo - CHI Health Jan 7, 2023
Heather M Morgan Individual Corporate Director Jul 1, 2020
Kirtibala Gupta Individual Corporate DirectorBod Jul 15, 2021
Evert Kuiper Individual Corporate DirectorCeo - CHI Health Jan 17, 2022
Operational/Managerial ControlCeo - CHI Health Jan 17, 2022
John E Petersdorf Individual Corporate Director Jan 21, 2021
William Yates Individual Corporate Director Oct 1, 2015
Connie Peters Individual Corporate DirectorRegional Health Administrator Jan 1, 2009
W-2 Managing Employee Jan 1, 2009
Mardell Wilson Individual Corporate Director Oct 15, 2020
Kelly Bacon Individual Corporate DirectorBod Jul 15, 2021

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 38

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 38

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1093890576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 PINE ST",
            "city": "CLARKSON",
            "state": "NE",
            "postal_code": "686294094",
            "telephone_number": "402-892-3466",
            "fax_number": "402-892-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 PINE ST",
            "city": "CLARKSON",
            "state": "NE",
            "postal_code": "686294094",
            "telephone_number": "402-892-3466",
            "fax_number": "402-892-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "KUIPER",
        "authorized_official_first_name": "EVERT",
        "authorized_official_title_or_position": "CEO - CHI HEALTH",
        "authorized_official_telephone_number": "402-343-4671"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Clinic Clarkson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Clinic Clarkson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarkson, NE

Sources for this page

Verify at the official NPI Registry.