Merrick Medical Center
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Central City, NE
NPI 1306377783 · NPPES record last updated Jul 24, 2024
Key facts
- NPI
- 1306377783
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 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
- Organization subpart
- Yes
- Parent organization (as reported)
- MERRICK MEDICAL CENTER
Authorized official
- Name
- Jodi S Mohr
- Title
- Ceo
- Phone
- (402) 946-3015
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
-
Blake Cover, M.D.
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 17
Practitioners 13
-
Rhianna W Becker, PA-C
-
Brian Keith Buhlke, D.O.
-
Blake Cover, M.D.
-
Traci A Dieckmann, D.O.
-
Brett Charles Hill, M.D.
-
Brandon Lee McLaughlin, P.A.
-
Natalie H Pearson, PA-C
-
Richard L Poppe, MD
-
Ryan Thomas Santin, M.D.
-
Cara E. Schiessler, APRN
-
Elisa Jean Zeiss, PA-C
Affiliated clinicians 2
-
Traci A Dieckmann, D.O.
-
Richard L Poppe, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Hospital certification: CCN 28Z328
- Legal name
- MERRICK MEDICAL CENTER
- Doing business as
- MERRICK MEDICAL CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 15, 2017 in NE
- Enrollment address
- 2802 28TH St
Central City, NE 68826-2707
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Nathan W Perry |
Corporate Officer | Feb 16, 2023 | |
| Corporate Director | Feb 16, 2023 | ||
| Shannon Hannappel |
Corporate Officer | Feb 18, 2021 | |
| Corporate Director | Dec 20, 2018 | ||
| Patrick D Ganyo |
Corporate Officer | Feb 16, 2023 | |
| Corporate Director | Feb 18, 2021 | ||
| Bryan Health |
Operational/Managerial Control | Mar 15, 2017 | |
| Blake a Cover |
Corporate Director | Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Operational/Managerial Control |
Jan 1, 2024 | ||
| Richard Lloyd |
Corporate Director | Sep 1, 2023 | |
| Jodi S Mohr |
Corporate Officer |
Jun 17, 2024 | |
| Corporate Director |
Jun 17, 2024 | ||
| W-2 Managing Employee |
Jun 17, 2024 | ||
| Operational/Managerial Control |
Jun 17, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170421001270 | NE | Part a Provider - Critical Access Hospital | 9537445812 | Practice locations: Central City, NE |
National Provider Directory
- Tax ID family
- Merrick Medical Center
- Part of
- Merrick Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | direct@hisp.bryanhealth.org |
Other providers in Central City, NE
- Connie Loseke
- Steven Scot Mahnke
- Shirley Jean McKinney
- Brandon Lee McLaughlin
- Merrick County
- Merrick Medical Center
- Merrick Medical Center
- Merrick Medical Center
- Merrick Medical Center
- Cheryl Morrison
All providers in Central City, NE · Medicare Defined Swing Bed Hospital Unit in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.