Crowell Memorial Home
Organization Active NPI Skilled Nursing Facility · Blair, NE
NPI 1376693010 · NPPES record last updated Dec 17, 2009
Key facts
- NPI
- 1376693010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 794001 (NE)
- Legal business name
- CROWELL MEMORIAL HOME
- Practice address
- 245 S 22ND St
Blair, NE 68008-1811 - Phone
- (402) 426-2177
- Fax
- (402) 426-2577
- NPI assigned
- Jan 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Bill Williard
- Title
- Executive Director
- Phone
- (402) 426-2177
Practitioners 4
-
Sandra Baumberger, M.D.
-
John K Simonson, MD
-
Kevin C Sisk, D.O.
Affiliated clinicians 6
-
Sandra Baumberger, M.D.
-
Amanda Duxbury, M.D.
-
Sean C. Erickson, MD
-
John K Simonson, MD
-
Kevin C Sisk, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Crowell Memorial Home
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jul 1, 1997
- Medicare certification status
- Active
- Certified beds
- 74 · 67.2 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $0
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0453427 | Crowell Memorial Home | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Skilled nursing facility certification: CCN 285210
- Legal name
- CROWELL MEMORIAL HOME
- Doing business as
- CROWELL MEMORIAL HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1997
- Last certification
- Jun 12, 2025
- Beds
- 74
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 31, 1927 in NE
- Enrollment address
- 245 S 22ND St
Blair, NE 68008-1811 - Nursing home name
- CROWELL MEMORIAL HOME
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Stacy Benner |
Corporate Director |
Oct 1, 2017 | |
| Operational/Managerial Control |
Oct 1, 2017 | ||
| Jaclyn Rolland |
Corporate Officer |
Dec 4, 2017 | |
| Corporate Director |
Dec 4, 2017 | ||
| W-2 Managing Employee |
Dec 4, 2017 | ||
| Operational/Managerial Control |
Dec 4, 2017 | ||
| Doug Anderson |
Corporate Officer |
Oct 1, 2017 | |
| Operational/Managerial Control | Oct 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070208000229 | NE | Part a Provider - Skilled Nursing Facility | 6204838949 | Practice locations: Blair, NE |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | ALF049 | NE | |
| Skilled Nursing Facility | 314000000X | 794001 | NE | Yes |
Addresses
Primary practice location
245 S 22ND St
Blair, NE 68008-1811
Mailing address
245 S 22ND St
Blair, NE 68008-1811
Phone (402) 426-2177
NPI Registry JSON
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1261008000000",
"number": "1376693010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 S 22ND ST",
"city": "BLAIR",
"state": "NE",
"postal_code": "680081811",
"telephone_number": "402-426-2177",
"fax_number": "402-426-2577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 S 22ND ST",
"city": "BLAIR",
"state": "NE",
"postal_code": "680081811",
"telephone_number": "402-426-2177",
"fax_number": "402-426-2577"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CROWELL MEMORIAL HOME",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-12",
"last_updated": "2009-12-17",
"status": "A",
"authorized_official_last_name": "WILLIARD",
"authorized_official_first_name": "BILL",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "402-426-2177"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "NE",
"license": "ALF049",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NE",
"license": "794001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Blair, NE · Skilled Nursing Facility in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2009. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.