Organization Active NPI

Ogallala Community Hospital

  • Rural Health Clinic/Center
  • Ogallala, NE
National Provider Identifier
1396455481
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
OGALLALA COMMUNITY HOSPITAL
Practice address
2601 N Spruce St Ste a
Ogallala, NE 69153-2465
Phone
(308) 284-4011
Fax
(308) 284-7212
NPI assigned
Nov 29, 2022
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Authorized official

Name
Timothy Gullingsrud
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2601 N Spruce St Ste a
Ogallala, NE 69153-2465

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Other names 1

  • Banner Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171107002773 NE Part A Provider - Rural Health Clinic 3072517523 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ogallala, NE

Rural health clinic certification: CCN 288548

Legal name
OGALLALA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 13, 2018
Last certification
Mar 13, 2018
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
2601 N Spruce St
Ste a
Ogallala, NE 69153-2465
Related CCNs
281355

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

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
Ogallala Community Hosp5 organizations share this tax ID, including this one
Part of
M E Lee MD

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Julie Ann Alvarado-Dubek Individual Corporate OfficerOfficer Feb 1, 2022
Marjorie J Bessel Individual Corporate OfficerOfficer Jan 1, 2018
Jean Lance Individual Corporate Officer Jun 30, 2022
Staci Dickerson Individual Corporate OfficerCfo Jul 17, 2023
W-2 Managing EmployeeCfo Jul 17, 2023
Carole Faig Individual Corporate DirectorBoard Member Mar 1, 2026
Paris Labruzzo Individual Corporate DirectorSr Director Dec 7, 2022
W-2 Managing Employee Dec 7, 2022
Timothy Gullingsrud Individual Corporate OfficerHospital Ceo Dec 2, 2019
W-2 Managing EmployeeHospital Ceo Dec 2, 2019
Dean M Harrison Individual Corporate DirectorBoard Member Sep 1, 2023
Anne Mariucci Individual Corporate DirectorBoard Member Mar 1, 2015
Sujata Gosalia Individual Corporate DirectorDirector Sep 1, 2018
Brenda a Schaefer Individual Corporate OfficerTreasurer Mar 6, 2014
Quentin P Smith Individual Corporate DirectorBoard Member Sep 1, 1999
Vicki Keiser Individual Corporate DirectorDirector Jun 1, 2017
Holly Gregory Individual Corporate DirectorSr Manager Jul 24, 2020
W-2 Managing Employee Jul 24, 2020
Sara Ward Individual Corporate DirectorBoard Member Sep 1, 2023
Michael L Butler Individual Corporate DirectorBoard Member Sep 1, 2025
Mary Schubert Individual Corporate OfficerAssistant Secretary Jan 1, 2024
Amy Perry Individual Corporate OfficerOfficer Nov 1, 2021
Rick Myers Individual Corporate DirectorDirector Sep 1, 2023
John F Koster Individual Corporate DirectorBoard Member Dec 11, 2015
Mark Wallace Individual Corporate DirectorDirector Sep 1, 2021
Christopher H Volk Individual Corporate DirectorBoard Member Sep 1, 1999
Michael Garnreiter Individual Corporate DirectorBoard Member Aug 1, 2012
Banner Health Organization, Phoenix, AZ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Operational/Managerial Control Jan 1, 2018 100%

Owners & managing parties with NPI records 12

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

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1396455481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 N SPRUCE ST STE A",
            "city": "OGALLALA",
            "state": "NE",
            "postal_code": "691532465",
            "telephone_number": "308-284-4011",
            "fax_number": "308-284-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OGALLALA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2022-11-29",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "GULLINGSRUD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogallala, NE

Sources for this page

Verify at the official NPI Registry.