Brodstone Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Nelson, NE
NPI 1114999547 · NPPES record last updated Sep 8, 2026
Key facts
- NPI
- 1114999547
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BRODSTONE MEMORIAL HOSPITAL
- Practice address
- 76 W 8TH St
Nelson, NE 68961-6130 - Phone
- (402) 225-2375
- Fax
- (402) 225-2375
- NPI assigned
- Feb 1, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- BRODSTONE MEMORIAL HOSPITAL
Authorized official
- Name
- Treg Vyzourek
- Title
- Ceo
- Phone
- (402) 879-3281
Owners & managing parties with NPI records 1
-
Timothy Blecha, MD
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Practitioners 16
-
Riley L Butler, PA-C
-
Alisha Fangmeyer, APRN
-
Timothy Blecha, MD
-
Barry A Bohlen, M.D.
-
Teresa B Frahm, NP
-
Matthew Gatlin, PA-C
-
Jason G Hass, P.A.
-
Raymond D. Heller, M.D.
-
Amy Nicole Rempe, PA
-
Julie A Theis, M.D.
-
Jessica Kirby, APRN, FNP-BC
-
Michelle Denise Schiel, APRN
-
Kelly Marie Stevenson, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D1006100 | Brodstone Family Medical Center - Nelson | Certificate of waiver | Nov 6, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Rural health clinic certification: CCN 283479
- Legal name
- BRODSTONE MEMORIAL HOSPITAL
- Doing business as
- BRODSTONE FAMILY MEDICAL CENTER - NELSON
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 1, 2004
- Last certification
- Jan 16, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 24, 1926 in NE
- Enrollment address
- 76 W 8TH St
Nelson, NE 68961-6130 - Related CCNs
- 281315
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Janet L Eggers |
Corporate Officer | Sep 24, 2018 | |
| Corporate Director | May 22, 2017 | ||
| Treg Vyzourek |
Corporate Officer |
Jan 22, 2018 | |
| W-2 Managing Employee |
Jan 22, 2018 | ||
| Operational/Managerial Control |
Jan 22, 2018 | ||
| Royce L Schott |
Corporate Officer | May 28, 2024 | |
| Corporate Director | May 31, 2022 | ||
| Piper a Hodge |
Corporate Officer | May 30, 2023 | |
| Corporate Director | May 30, 2023 | ||
| Judy a Baker |
W-2 Managing Employee |
Oct 1, 2002 | |
| Operational/Managerial Control |
Oct 1, 2002 | ||
| Sandra Borden |
Corporate Director | May 28, 2024 | |
| Beth Siebecker |
Corporate Officer | May 25, 2021 | |
| Corporate Director | Jul 30, 2018 | ||
| Jacqueline Porter |
Corporate Director | May 23, 2016 | |
| Timothy D Blecha |
W-2 Managing Employee |
Oct 1, 2004 | |
| Operational/Managerial Control |
Oct 1, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040311001136 | NE | Part a Provider - Rural Health Clinic | 4082513015 | Practice locations: Nelson, NE |
| O20040423000949 | NE | Part B Supplier - Clinic/Group Practice | 4082513015 |
Receives reassigned benefits from 27 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Deshler, NE; Superior, NE |
National Provider Directory
- Part of
- Brodstone Memorial Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
76 W 8TH St
Nelson, NE 68961-6130
Mailing address
PO Box 407
Superior, NE 68978-0407
Phone (402) 879-4781
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025184500 | Medicaid | NE | |
| 10025288600 | Medicaid | NE |
Other names
- BRODSTONE FAMILY MEDICAL CENTER - NELSON
- NELSON FAMILY MEDICAL CENTER
Other providers in Nelson, NE
- Destiny Aguirre
- Holly Bower
- Lisa Brown
- City of Nelson
- Mallory Loretta Elting
- Kerri Rennick
- Barb Samsula
All providers in Nelson, NE · Rural Health Clinic/Center in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2026. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.