NPIMap

Organization Active NPI

Bluestem Health

  • Federally Qualified Health Center (FQHC)
  • Lincoln, NE
National Provider Identifier
1184194557
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BLUESTEM HEALTH
Practice address
3100 N 14TH St
Lincoln, NE 68521-2134
Phone
(402) 476-1455
Fax
(402) 476-1670
NPI assigned
Nov 28, 2018
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Brad Lee Meyer
Title
Ceo
Phone
(402) 470-5424

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

3100 N 14TH St
Lincoln, NE 68521-2134

Mailing address

1021 N 27TH St
Lincoln, NE 68503-1803
Phone (402) 476-1455

Other identifiers 2

IdentifierTypeStateIssuer
10026494204MedicaidNE
10026494206MedicaidNE

Other names 1

  • Bluestem Health Kreshel Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000213 NE Part B Supplier - Clinic/Group Practice 6800706672 Receives reassigned benefits from 31 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lincoln, NE
O20190304000380 NE Part A Provider - Federally Qualified Health Center (FQHC) 6800706672 Practice locations: Lincoln, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184194557. Details of each certification follow.

Federally qualified health center certification: CCN 281847

Legal name
BLUESTEM HEALTH
Doing business as
BLUESTEM HEALTH KRESHEL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2019
Last certification
Mar 1, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 21, 2002 in NE
Enrollment address
3100 N 14TH St
Ste 201
Lincoln, NE 68521-2134

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
28D0455347Bluestem Health Kreshel Clinic3100 North 14TH Street Suite 201, Lincoln, NE 68521Certificate of waiverMar 31, 2027

National Provider Directory

National Provider Directory

Locations

3100 N 14th St
Lincoln, NE 68521
Phone (402) 477-6600

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jacque Fanning Individual Corporate OfficerCfo Sep 6, 2016
W-2 Managing EmployeeCfo Sep 6, 2016
Brad Meyer Individual Corporate OfficerCeo Sep 15, 2014
W-2 Managing EmployeeCeo Sep 15, 2014
Operational/Managerial ControlCeo Sep 15, 2014

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1184194557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 N 27TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685031803",
            "telephone_number": "402-476-1455",
            "fax_number": "402-476-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 N 14TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685212134",
            "telephone_number": "402-476-1455",
            "fax_number": "402-476-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESTEM HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-28",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-470-5424"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026494204",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026494206",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluestem Health Kreshel Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bluestem Health Kreshel Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.