NPIMap

Organization Active NPI

Grand Island Regional Medical Center

  • Emergency Medicine Physician
  • Grand Island, NE
National Provider Identifier
1225658495
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
GRAND ISLAND REGIONAL MEDICAL CENTER
Practice address
3533 Prairieview St
Grand Island, NE 68803-4409
Phone
(308) 675-5000
NPI assigned
Apr 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Andrew P Waterman
Title
Ceo
Phone
(308) 675-5000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

3533 Prairieview St
Grand Island, NE 68803-4409

Mailing address

PO Box 5225
Grand Island, NE 68802-5225
Phone (308) 675-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200904000271 NE Part B Supplier - Clinic/Group Practice 0143659508 Receives reassigned benefits from 78 practitioners
Practice locations: Grand Island, NE

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3563 Prairieview St
Ste 140
Grand Island, NE 68803
Phone (308) 675-5000

Practitioners & affiliated clinicians

Practitioners 87

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 87

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1225658495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5225",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688025225",
            "telephone_number": "308-675-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 PRAIRIEVIEW ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034409",
            "telephone_number": "308-675-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ISLAND REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-17",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "WATERMAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-675-5000"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.