NPIMap

Organization Active NPI

Kearney Co Health Services

Doing business as Minden Medical Clinic

  • Rural Health Clinic/Center
  • Minden, NE
National Provider Identifier
1205977873
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KEARNEY CO HEALTH SERVICES
Doing business as
Minden Medical Clinic
Practice address
727 E 1St St
Minden, NE 68959-1705
Phone
(308) 832-3400
Fax
(308) 832-3414
NPI assigned
Feb 8, 2007
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KEARNEY CO HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Luke D Poore
Title
Ceo
Phone
(308) 832-3400

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

727 E 1St St
Minden, NE 68959-1705

Mailing address

727 E 1St St
Minden, NE 68959-1705
Phone (308) 832-3400

Other names 1

  • Minden Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040223001142 NE Part B Supplier - Clinic/Group Practice 8820900780 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
Practice locations: Minden, NE
O20050114000094 NE Part A Provider - Rural Health Clinic 8820900780 Practice locations: Minden, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205977873. Details of each certification follow.

Rural health clinic certification: CCN 283416

Legal name
KEARNEY CO HEALTH SERVICES
Doing business as
MINDEN MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 23, 1995
Last certification
Mar 4, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
727 E 1St St
Minden, NE 68959-1705
Related CCNs
281306

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Kearney County Comm Hospi

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/afb10dcd-fcfe-4394-bcee-f9c44a02df40/

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Janell Shelton Individual W-2 Managing EmployeeAd;Clinic Director Aug 18, 2008
Operational/Managerial ControlClinic Director Aug 18, 2008
Gavin D Blum Individual Corporate OfficerCfo Dec 16, 2019
W-2 Managing EmployeeCfo Dec 16, 2019
Operational/Managerial ControlCfo Dec 16, 2019
Andrew P Grollmes Individual Corporate Director Jan 7, 2025
Stephen W Olson Individual Corporate Officer Jan 26, 2022
Corporate Director Jan 1, 2017
Samuel L Stadler Individual Corporate Director Feb 12, 2018
Douglas J Althouse Individual W-2 Managing EmployeeMD; Jan 1, 2015
Operational/Managerial ControlMedical Director Jan 1, 2015
Jeffrey Hanson Individual Corporate Director Jan 1, 2012
Luke D Poore Individual Corporate OfficerCeo Apr 18, 2016
W-2 Managing EmployeeCeo Apr 18, 2016
Operational/Managerial ControlCeo Apr 18, 2016
Aaron J Dahlgren Individual Corporate Officer Jan 25, 2023
Corporate Director Apr 27, 2022

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1205977873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 E 1ST ST",
            "city": "MINDEN",
            "state": "NE",
            "postal_code": "689591705",
            "telephone_number": "308-832-3400",
            "fax_number": "308-832-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 E 1ST ST",
            "city": "MINDEN",
            "state": "NE",
            "postal_code": "689591705",
            "telephone_number": "308-832-3400",
            "fax_number": "308-832-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEARNEY CO HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEARNEY CO HEALTH SERVICES",
        "enumeration_date": "2007-02-08",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "POORE",
        "authorized_official_first_name": "LUKE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-832-3400"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minden Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minden Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minden, NE

Sources for this page

Verify at the official NPI Registry.