NPIMap

Organization Active NPI

Memorial Community Hospital Corporation

  • Rural Health Clinic/Center
  • Fort Calhoun, NE
National Provider Identifier
1417015207
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL COMMUNITY HOSPITAL CORPORATION
Practice address
4929 County Road P43
Fort Calhoun, NE 68023-5066
Phone
(402) 468-4655
Fax
(402) 468-4633
NPI assigned
Dec 5, 2006
Organization subpart
Yes
Parent organization
MEMORIAL COMMUNITY HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Amy Zimmer
Title
Cne/VP Patient Care Services
Phone
(402) 426-2182

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 79001 NE
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4929 County Road P43
Fort Calhoun, NE 68023-5066

Mailing address

4929 County Road P43
Fort Calhoun, NE 68023-5066
Phone (402) 468-4655

Other identifiers 1

IdentifierTypeStateIssuer
07683OtherNEBLUE CROSS BLUE SHIELD

Other names 1

  • Fort Calhoun 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
O20040202001065 NE Part B Supplier - Clinic/Group Practice 0749190775 Receives reassigned benefits from 84 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tekamah, NE; Fort Calhoun, NE; Blair, NE
O20100315000233 NE Part A Provider - Rural Health Clinic 0749190775 Practice locations: Fort Calhoun, NE

Rural health clinic certification: CCN 288506

Legal name
MEMORIAL COMMUNITY HOSPITAL CORPORATION
Doing business as
FORT CALHOUN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 20, 2010
Last certification
Dec 7, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1963 in NE
Enrollment address
4929 County Road P43
Fort Calhoun, NE 68023-5066
Related CCNs
281359

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Cott Rural Health Clinic

Locations

4929 County Road P43
Fort Calhoun, NE 68023
Phone (402) 426-1629

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Memorial Community Hospital Corporation Organization, Blair, NE Non-profit Operational/Managerial Control Apr 1, 2002 60%
Alegent Creighton Health Organization, Omaha, NE Non-profit Other Apr 1, 2002
Manuela Wolf Individual Contracted Managing EmployeePresident/Ceo Mar 1, 2018
Operational/Managerial ControlPresident/Ceo Mar 1, 2018
Amy Zimmer Individual Corporate OfficerCne/VP of Patient Services Dec 7, 2020
Corporate DirectorCne/VP of Patient Services Dec 7, 2020
W-2 Managing EmployeeCne/VP Patient Care Services Dec 7, 2020
Operational/Managerial ControlCne/VP of Patient Services Dec 7, 2020
Evert Kuiper Individual Other Jan 1, 2022
Alegent Health Immanuel Medical Center Organization, Omaha, NE Non-profit Operational/Managerial Control Apr 1, 2002 40%
Melissa Templar Individual W-2 Managing EmployeeMedical Staff Services Lead Aug 15, 2011

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Operational/Managerial Control (60%) Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Operational/Managerial Control (60%) Apr 1, 2002
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 Rural health clinic Operational/Managerial Control (60%) Apr 1, 2002
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Operational/Managerial Control (60%) Apr 1, 2002

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners 28

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

View all 28

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
28D0910916Fort Calhoun Clinic4929 County Road P43, Fort Calhoun, NE 68023Provider-performed microscopyJul 2, 2028

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1417015207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4929 COUNTY ROAD P43",
            "city": "FORT CALHOUN",
            "state": "NE",
            "postal_code": "680235066",
            "telephone_number": "402-468-4655",
            "fax_number": "402-468-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4929 COUNTY ROAD P43",
            "city": "FORT CALHOUN",
            "state": "NE",
            "postal_code": "680235066",
            "telephone_number": "402-468-4655",
            "fax_number": "402-468-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "enumeration_date": "2006-12-05",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "ZIMMER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CNE/VP PATIENT CARE SERVICES",
        "authorized_official_telephone_number": "402-426-2182"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NE",
            "license": "79001",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "07683",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Calhoun Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Calhoun Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Calhoun, NE

Sources for this page

Verify at the official NPI Registry.