NPIMap

Organization Active NPI

Jennie M Melham Memorial Medical Center Inc

  • Certified Registered Nurse Anesthetist
  • Broken Bow, NE
National Provider Identifier
1366659773
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Practice address
145 Memorial Dr
Broken Bow, NE 68822-1378
Phone
(308) 872-4100
Fax
(308) 872-4175
NPI assigned
May 16, 2007
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Kyle D Kellum
Title
Ceo and President
Phone
(308) 872-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary

Addresses

Primary practice location

145 Memorial Dr
Broken Bow, NE 68822-1378

Mailing address

PO Box 250
Broken Bow, NE 68822-0250
Phone (308) 872-4100

Other identifiers 4

IdentifierTypeStateIssuer
DB7316OtherNERAILROAD MEDICARE NUMBER
07073OtherNEBLUE CROSS CRNA NUMBER
10025055300MedicaidNE
81010OtherNEBLUE CROSS DIABETIC ED NO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040527000928 NE Part B Supplier - Clinic/Group Practice 5799766440 Receives reassigned benefits from 30 practitioners
1 other NPI on this enrollment
Practice locations: Broken Bow, NE

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Jennie M Melham Med Ctr4 organizations share this tax ID, including this one
Part of
Jennie M Melham Med Ctr

Other organizations with this tax ID 3

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

Locations

4600 Valley Rd
Lincoln, NE 68510
Phone (402) 483-4571

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1366659773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688220250",
            "telephone_number": "308-872-4100",
            "fax_number": "308-872-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MEMORIAL DR",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688221378",
            "telephone_number": "308-872-4100",
            "fax_number": "308-872-4175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC",
        "enumeration_date": "2007-05-16",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "KELLUM",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "308-872-4100"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "DB7316",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS CRNA NUMBER",
            "identifier": "07073",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025055300",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS DIABETIC ED NO",
            "identifier": "81010",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Bow, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.