NPIMap

Organization Active NPI

West Holt Memorial Hospital

Doing business as West Holt Medical Clinic

  • General Practice Physician
  • Atkinson, NE
National Provider Identifier
1366492472
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WEST HOLT MEMORIAL HOSPITAL
Doing business as
West Holt Medical Clinic
Practice address
405 W Pearl St
Atkinson, NE 68713-4882
Phone
(402) 925-2631
Fax
(402) 925-2914
NPI assigned
May 11, 2006
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
Jeremy Bauer
Title
Cfo
Phone
(402) 925-1947

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

405 W Pearl St
Atkinson, NE 68713-4882

Mailing address

PO Box 458
Atkinson, NE 68713-0458
Phone (402) 925-2631

Other names 1

  • West Holt Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000936 NE Part B Supplier - Clinic/Group Practice 2264419878 Receives reassigned benefits from 18 practitioners
Practice locations: Atkinson, NE
O20050308000385 NE Part A Provider - Rural Health Clinic 2264419878 Practice locations: Atkinson, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366492472. Details of each certification follow.

Rural health clinic certification: CCN 283488

Legal name
WEST HOLT MEMORIAL HOSPITAL
Doing business as
WEST HOLT MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 1, 2005
Last certification
Dec 16, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1973 in NE
Enrollment address
405 W Pearl St
Atkinson, NE 68713-4882
Related CCNs
281343

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

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0455566West Holt Medical Clinic405 West Pearl, Atkinson, NE 68713Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory

Locations

406 W Neely St
Atkinson, NE 68713
Phone (402) 925-2811

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Michael Peek Individual Corporate DirectorBoard Member Aug 1, 2022
Marsha Thurlow Individual Corporate DirectorBoard Member Aug 1, 2022
Trent Schaaf Individual Corporate DirectorBoard Member Aug 1, 2022
Lori Olson Individual Corporate DirectorBoard Member Aug 1, 2022
Taylor McCormick Individual Corporate OfficerChief Financial Officer Oct 12, 2022
Bryan Rentschler Individual Corporate DirectorBoard Vice President Oct 22, 2007
Susan Myers Individual Corporate DirectorBoard Member Oct 30, 2017
Jeremy Bauer Individual Corporate Officer Dec 1, 2018 100%
W-2 Managing EmployeeCeo Dec 1, 2018
Matthew Fritz Individual Corporate DirectorBoard Member Nov 6, 2023
Thomas Dvorak Individual Corporate DirectorBoard Member Aug 1, 2022
Brett Lieswald Individual Corporate DirectorBoard Member Aug 1, 2022

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1366492472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "ATKINSON",
            "state": "NE",
            "postal_code": "687130458",
            "telephone_number": "402-925-2631",
            "fax_number": "402-925-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W PEARL ST",
            "city": "ATKINSON",
            "state": "NE",
            "postal_code": "687134882",
            "telephone_number": "402-925-2631",
            "fax_number": "402-925-2914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HOLT MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "402-925-1947"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Holt Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Holt Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atkinson, NE

Sources for this page

Verify at the official NPI Registry.