NPIMap

Organization Active NPI

Antelope Memorial Hospital

Doing business as AMH Elgin Clinic

  • Rural Health Clinic/Center
  • Elgin, NE
National Provider Identifier
1184705477
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANTELOPE MEMORIAL HOSPITAL
Doing business as
AMH Elgin Clinic
Practice address
101 West Cedar St
Elgin, NE 68636-4490
Phone
(402) 843-5444
NPI assigned
Oct 17, 2006
Last updated
Nov 18, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTELOPE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
Diane M Brugger
Title
Administrator
Phone
(402) 887-4151

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

101 West Cedar St
Elgin, NE 68636-4490

Mailing address

PO Box 109
Neligh, NE 68756-0109
Phone (402) 887-5440

Other names 1

  • AMH Elgin Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040709000331 NE Part A Provider - Rural Health Clinic 5496733156 Practice locations: Elgin, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184705477. Details of each certification follow.

Rural health clinic certification: CCN 283472

Legal name
ANTELOPE MEMORIAL HOSPITAL
Doing business as
AMH ELGIN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2004
Last certification
May 10, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 1952 in NE
Enrollment address
101 W Cedar St
Elgin, NE 68636-4490
Related CCNs
281326

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

Other NPIs with the same Medicare PAC ID 8

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
28D0935049Amh - Elgin Clinic101 West Cedar Street, Elgin, NE 68636Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Amh Family Practice10 organizations share this tax ID, including this one
Part of
Amh Family Practice

Other organizations with this tax ID 9

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

Locations

101 W Cedar St
Elgin, NE 68636
Phone (402) 843-5444

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Troy Olan Dawson Individual W-2 Managing EmployeeMD; Jul 1, 2004
Operational/Managerial ControlMedical Director Jul 1, 2004
Maury M Soper Individual Corporate Director Mar 24, 2021
Gordon W Shrader Individual Corporate Director May 1, 2009
David P Sullivan Individual Corporate Director Jun 1, 1999
Tanya Sharp Individual W-2 Managing EmployeeAd;Chief Clinical Operations Office Oct 9, 2023
Operational/Managerial ControlChief Clinical Operations Officer Oct 9, 2023
Jon Schilling Individual Corporate Director Nov 24, 2015
Samantha Stoltz Individual Corporate Officer Jun 25, 2025
Corporate Director Jul 28, 2015
John J Mlnarik Individual Corporate Officer Nov 1, 2009
Corporate Director Feb 1, 1985
Russell M Vetick Individual Corporate Director Jul 24, 2018
Robert E Johnston Individual Corporate Director Jan 29, 2025
Thomas J Zwingman Individual Corporate Director Nov 28, 2018
Diane M Brugger Individual Corporate OfficerAdministrator Mar 1, 2019
W-2 Managing EmployeeAdministrator Mar 1, 2019
Operational/Managerial ControlAdministrator Mar 1, 2019
James E Meuret Individual Corporate Officer Jul 29, 2020
Corporate Director Aug 1, 1995

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1184705477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 109",
            "city": "NELIGH",
            "state": "NE",
            "postal_code": "687560109",
            "telephone_number": "402-887-5440",
            "fax_number": "402-887-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WEST CEDAR ST",
            "city": "ELGIN",
            "state": "NE",
            "postal_code": "686364490",
            "telephone_number": "402-843-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTELOPE MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "BRUGGER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "402-887-4151"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMH Elgin Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AMH Elgin Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elgin, NE

Sources for this page

Verify at the official NPI Registry.