Organization Active NPI

Country Clinics PC

Doing business as St Edward Medical Clinic

  • Clinic/Center
  • Saint Edward, NE
National Provider Identifier
1225063266
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
28D0455470 Issued in NE
Legal business name
COUNTRY CLINICS PC
Doing business as
St Edward Medical Clinic
Practice address
1102 Water St
St Edward, NE 68660-0167
Phone
(402) 678-2232
Fax
(402) 678-2234
NPI assigned
Jul 11, 2006
Last updated
Sep 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Authorized official

Name
Joyce A Troyer, MDNPI 1306839295
Title
Corporation Secretary
Phone
(402) 678-2232

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 28D0455470 NE Primary

Addresses

Primary practice location

1102 Water St
St Edward, NE 68660-0167

Mailing address

PO Box F
St Edward, NE 68660-0167
Phone (402) 678-2232

Other identifiers 1

IdentifierTypeStateIssuer
10025570200MedicaidNE

Other names 1

  • St Edward Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603000825 NE Part B Supplier - Clinic/Group Practice 3870575806 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Edward, NE

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2025 Change of OwnershipThis provider was the seller St Edward Medical ClinicCCN 288560, NE, NPI 1144119488

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1225063266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX F",
            "city": "ST EDWARD",
            "state": "NE",
            "postal_code": "686600167",
            "telephone_number": "402-678-2232",
            "fax_number": "402-678-2234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WATER ST",
            "city": "ST EDWARD",
            "state": "NE",
            "postal_code": "686600167",
            "telephone_number": "402-678-2232",
            "fax_number": "402-678-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLINICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "TROYER",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CORPORATION SECRETARY",
        "authorized_official_telephone_number": "402-678-2232",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NE",
            "license": "28D0455470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025570200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Edward Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Edward Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Edward, NE

Sources for this page

Verify at the official NPI Registry.