NPIMap

Organization Active NPI

Cheyenne County Hospital Association Inc

Doing business as Sidney Regional Medical Center

  • Critical Access Hospital
  • Sidney, NE
National Provider Identifier
1487736963
Registry record updated Dec 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
150001 Issued in NE
Legal business name
CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Doing business as
Sidney Regional Medical Center
Practice address
1000 Pole Creek Crossing
Sidney, NE 69162-2900
Phone
(308) 254-5825
Fax
(308) 254-2300
NPI assigned
Oct 20, 2006
Last updated
Dec 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2015

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

Authorized official

Name
Ms. Kelly K Utley
Title
Cfo
Phone
(308) 254-5064

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 150001 NE
Critical Access Hospital 282NC0060X 150001 NE Primary
Physician Assistant 363A00000X NU
Emergency Medicine Physician 207P00000X NU

Addresses

Primary practice location

1000 Pole Creek Crossing
Sidney, NE 69162-2900

Mailing address

1000 Pole Creek Crossing
Sidney, NE 69162-2900
Phone (308) 254-5064

Other identifiers 1

IdentifierTypeStateIssuer
00133OtherNEPROVIDER # FOR BLUE CROSS

Other names 1

  • Sidney Regional Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050301000906 NE Part B Supplier - Clinic/Group Practice 1658345657 Receives reassigned benefits from 80 practitioners
1 other NPI on this enrollment
Practice locations: Bridgeport, NE; Kimball, NE; Sidney, NE
O20071128000896 NE Part A Provider - Critical Access Hospital 1658345657 Receives reassigned benefits from 59 practitioners
Practice locations: Sidney, NE
O20071128000898 NE Part A Provider - Critical Access Hospital 1658345657 Practice locations: Sidney, NE

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1487736963. Details of each certification follow.

Hospital certification: CCN 281357

Legal name
CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Doing business as
SIDNEY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2002
Last certification
Jan 25, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1951 in NE
Enrollment address
1000 Pole Creek Xing
Sidney, NE 69162-2900
Other Hospital Practice Location

Hospital certification: CCN 28Z357

Legal name
CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Doing business as
SIDNEY REGIONAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1951 in NE
Enrollment address
1000 Pole Creek Xing
Sidney, NE 69162-2900
Other Hospital Practice Location

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

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Sidney Regional Medical CenterCCN 281357 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Jeffrey J Heller Individual Corporate Director Jan 1, 2020
Sara M Sholar Individual Corporate DirectorChief of Medical Staff Jan 1, 2022
W-2 Managing EmployeeChief of Medical Staff Jan 1, 2022
Operational/Managerial ControlChief of Medical Staff Jan 1, 2022
Kathryn E Narjes Individual Corporate Officer Jan 1, 2017
Corporate Director Jul 24, 2012
Clement D Schumacher Individual Corporate Director Jan 1, 2020
Jason Patrick Petik Individual Contracted Managing EmployeeCeo Jun 2, 2011
Corporate OfficerCeo Nov 24, 2015
Operational/Managerial ControlCeo Jun 2, 2011
Jeffrey D Ellwanger Individual Corporate Officer Jan 1, 2011
Corporate Director Oct 1, 2003
Nanci M McCaslin Individual Corporate Director Jan 30, 2018
William J Pile Individual Corporate Officer Jan 1, 2011
Corporate Director Jan 1, 2006
Timothy Lee Miller Individual Corporate Officer Jan 1, 2011
Corporate Director Jan 1, 2009
Stanley D Belieu Individual Corporate Director Jan 1, 2007
Kelly K Utley Individual Corporate OfficerCfo Nov 24, 2015
W-2 Managing EmployeeCfo May 1, 2006
Operational/Managerial ControlCfo May 1, 2006
William Edgar Robinson Individual Corporate Director Jan 1, 1991
Rebecca L Allard Individual Corporate Director Jan 1, 2017
James Kenneth Popovich Individual Corporate Director Jan 1, 2023
April Nicole Smith Individual Corporate Director Jan 1, 2024
W-2 Managing EmployeeChief of Medical Staff Jan 1, 2024
Operational/Managerial ControlChief of Medical Staff Jan 1, 2024

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 81

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 81

Affiliated clinicians 123

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450656000000",
    "number": "1487736963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 POLE CREEK CROSSING",
            "city": "SIDNEY",
            "state": "NE",
            "postal_code": "691622900",
            "telephone_number": "308-254-5064",
            "fax_number": "308-254-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 POLE CREEK CROSSING",
            "city": "SIDNEY",
            "state": "NE",
            "postal_code": "691622900",
            "telephone_number": "308-254-5825",
            "fax_number": "308-254-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE COUNTY HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2015-12-21",
        "status": "A",
        "authorized_official_last_name": "UTLEY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "308-254-5064",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NE",
            "license": "150001",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NE",
            "license": "150001",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER # FOR BLUE CROSS",
            "identifier": "00133",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sidney Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sidney, NE

Sources for this page

Verify at the official NPI Registry.