NPIMap

Organization Active NPI

Merrick Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Central City, NE
National Provider Identifier
1306377783
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
MERRICK MEDICAL CENTER
Practice address
2802 28TH St
Central City, NE 68826-2707
Phone
(308) 946-3015
NPI assigned
Mar 27, 2017
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MERRICK MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Jodi S Mohr
Title
Ceo
Phone
(402) 946-3015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

2802 28TH St
Central City, NE 68826-2707

Mailing address

PO Box 860874
Minneapolis, MN 55486-0874
Phone (308) 946-3015

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@hisp.bryanhealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170421001270 NE Part A Provider - Critical Access Hospital 9537445812 Practice locations: Central City, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306377783. Details of each certification follow.

Hospital certification: CCN 28Z328

Legal name
MERRICK MEDICAL CENTER
Doing business as
MERRICK MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 15, 2017 in NE
Enrollment address
2802 28TH St
Central City, NE 68826-2707
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Merrick Medical Center3 organizations share this tax ID, including this one
Part of
Merrick Medical Center

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Nathan W Perry Individual Corporate Officer Feb 16, 2023
Corporate Director Feb 16, 2023
Shannon Hannappel Individual Corporate Officer Feb 18, 2021
Corporate Director Dec 20, 2018
Patrick D Ganyo Individual Corporate Officer Feb 16, 2023
Corporate Director Feb 18, 2021
Bryan Health Organization, Lincoln, NE Corporation, Non-profit, Chain home office Operational/Managerial Control Mar 15, 2017
Blake a Cover Individual Corporate Director Jan 1, 2024
W-2 Managing EmployeeChief of Staff Jan 1, 2024
Operational/Managerial ControlChief of Staff Jan 1, 2024
Richard Lloyd Individual Corporate Director Sep 1, 2023
Jodi S Mohr Individual Corporate OfficerCeo Jun 17, 2024
Corporate DirectorCeo Jun 17, 2024
W-2 Managing EmployeeCeo Jun 17, 2024
Operational/Managerial ControlCeo Jun 17, 2024

Owners & managing parties with NPI records 1

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

  • Blake Cover, M.D.
    • Family Medicine Physician
    • Omaha, NE
    • NPI 1225484934

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

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

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1306377783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860874",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860874",
            "telephone_number": "308-946-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 28TH ST",
            "city": "CENTRAL CITY",
            "state": "NE",
            "postal_code": "688262707",
            "telephone_number": "308-946-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERRICK MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERRICK MEDICAL CENTER",
        "enumeration_date": "2017-03-27",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "MOHR",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-946-3015"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@hisp.bryanhealth.org",
            "affiliation": "N",
            "address_1": "1600 S 48th St",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685061299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Central City, NE

Sources for this page

Verify at the official NPI Registry.