Memorial Health Care Systems
Organization Active NPI Rural Health Clinic/Center · Utica, NE
NPI 1154400844 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1154400844
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MEMORIAL HEALTH CARE SYSTEMS
- Practice address
- 100 4TH St
Utica, NE 68456-6016 - Phone
- (402) 534-2081
- Fax
- (402) 534-2187
- NPI assigned
- Nov 3, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MEMORIAL HEALTH CARE SYSTEMS
Authorized official
- Name
- Mr. Gregory E. Jerger
- Title
- Cfo
- Phone
- (402) 646-4628
Owners & managing parties with NPI records 1
-
Trisha Marie Sams, M.D.
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Practitioners 27
-
Eldridge G Burns Jr., M.D.
-
Corinn Renee Cook, PA-C
-
Amy K. Fischer, PA-C
-
Joel Douglas Gabriel, M.D.
-
Leah J Hays, PA-C
-
Brandon Jay Henley, D.O.
-
Jacqueline L Hobbs, M.D.
-
Jared B Ketner, M.D.
-
Connie J Novak, M.D.
-
James A Plasek, M.D.
-
Trisha Marie Sams, M.D.
-
John J Summa, M.D.
-
Heidi M Zywiec, PA-C
-
Cason Terryl Bock, PA C
-
Jason S Brooks, PA-C
-
Logan McGuffey, MD
-
David P Rickson, MD
-
Jonathan L. Spencer, M.D.
-
Jonathan Wood, MD
-
Daniel Alekyan, DO
-
Naganna Channaveeraiah, M.D, MBA, CPE
-
Vanessa Kay Cook, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0857446 | Utica Family Medical Center | Provider-performed microscopy | Jan 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Rural health clinic certification: CCN 283994
- Legal name
- MEMORIAL HEALTH CARE SYSTEMS
- Doing business as
- UTICA FAMILY MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 10, 1993
- Last certification
- Oct 27, 2020
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 9, 1947 in NE
- Enrollment address
- 100 4TH St
Utica, NE 68456-6016 - Related CCNs
- 281339
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Jill E Eberspacher |
Corporate Director | Jan 29, 2021 | |
| Roger Reamer |
Corporate Officer |
Jun 25, 2014 | |
| W-2 Managing Employee |
Jun 15, 2000 | ||
| Operational/Managerial Control |
Jun 15, 2000 | ||
| Trisha M Sams |
W-2 Managing Employee |
Jul 1, 2007 | |
| Operational/Managerial Control |
Jul 1, 2007 | ||
| Lana R Daws |
Corporate Director | Jan 19, 2018 | |
| Michael E Tomes |
Corporate Officer | Jan 29, 2021 | |
| Corporate Director | Jan 19, 2018 | ||
| Gregory Jerger |
Corporate Officer |
Jun 25, 2014 | |
| W-2 Managing Employee |
Aug 27, 1992 | ||
| Operational/Managerial Control |
Aug 27, 1992 | ||
| Michael E Hecker |
Corporate Officer | Jan 19, 2018 | |
| Corporate Director | Jan 27, 2017 | ||
| Joseph Caldwell |
W-2 Managing Employee |
Dec 2, 2019 | |
| Operational/Managerial Control |
Dec 2, 2019 | ||
| Kevin W Wingard |
Corporate Director | Jan 18, 2019 | |
| Bradley Perdue |
Corporate Director | Feb 22, 2023 | |
| Donna L Havener |
Corporate Officer | Apr 27, 2022 | |
| Corporate Director | Jan 29, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000511 | NE | Part a Provider - Rural Health Clinic | 3274528989 | Practice locations: Utica, NE |
National Provider Directory
- Tax ID family
- Memorial Clinic
- Part of
- Memorial Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
100 4TH St
Utica, NE 68456-6016
Mailing address
250 N Columbia Ave
Seward, NE 68434-2248
Phone (402) 643-4800
Other names
- Utica Family Medical Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mhcsseward@mhcs.medalliesdirect.net |
Other providers in Utica, NE
- Beth Johnson
- June B Kimm
- Dawn Michelle Klement
- Sarah Ledoux
- Amanda Lostroh
- Roger H Meyer
- Erin Pavlish
- Melanie Pedersen
- Sheena Perkins
- Vickie Prochaska
All providers in Utica, 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 Nov 9, 2023. 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.