NPIMap

Organization Active NPI

Heartland Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Grand Island, NE
National Provider Identifier
1275954299
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
HC069 Issued in NE
Legal business name
HEARTLAND HEALTH CENTER, INC.
Doing business as
Heartland Health Center, Inc.
Practice address
2116 W Faidley Ave Ste 2100
Grand Island, NE 68803-4678
Phone
(308) 382-4297
Fax
(308) 382-4376
NPI assigned
Dec 17, 2013
Last updated
Mar 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Authorized official

Name
Mrs. Terri R. Ford-Wolfgram, LCSW
Title
Ceo
Phone
(308) 382-4297

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Federally Qualified Health Center (FQHC) 261QF0400X HC069 NE Primary

Addresses

Primary practice location

2116 W Faidley Ave Ste 2100
Grand Island, NE 68803-4678

Mailing address

2116 W Faidley Ave Ste 2100
Grand Island, NE 68803-4678
Phone (308) 382-4297

Other identifiers 1

IdentifierTypeStateIssuer
100263881-00MedicaidNE

Other names 1

  • Heartland Health Center, Inc. Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140416000942 NE Part B Supplier - Clinic/Group Practice 6103058607 Receives reassigned benefits from 19 practitioners
4 other NPIs on this enrollment
Practice locations: Ravenna, NE; Hastings, NE; Grand Island, NE
O20141015001758 NE Part A Provider - Federally Qualified Health Center (FQHC) 6103058607 Practice locations: Grand Island, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275954299. Details of each certification follow.

Federally qualified health center certification: CCN 281833

Legal name
HEARTLAND HEALTH CENTER INC
Doing business as
HEARTLAND HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 2014
Last certification
Nov 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2116 W Faidley Ave
Ste 2100
Grand Island, NE 68803-4678

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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Heartland Health Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

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

Locations

2116 W Faidley Ave
Ste 2100
Grand Island, NE 68803
Phone (308) 382-4297

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
Tami Smith Individual Corporate DirectorCeo Jan 2, 2018
W-2 Managing EmployeeCeo Jan 2, 2018
Laura Salber Individual Corporate DirectorHR Director Jul 18, 2016
W-2 Managing EmployeeHR Director Jul 18, 2016

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1275954299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 W FAIDLEY AVE STE 2100",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034678",
            "telephone_number": "308-382-4297",
            "fax_number": "308-382-4376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 W FAIDLEY AVE STE 2100",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034678",
            "telephone_number": "308-382-4297",
            "fax_number": "308-382-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-17",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "FORD-WOLFGRAM",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-382-4297",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": "HC069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100263881-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heartland Health Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Island, NE

Sources for this page

Verify at the official NPI Registry.