Boone County Health Center
Organization Active NPI Rural Health Clinic/Center · Spalding, NE
NPI 1497789812 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1497789812
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BOONE COUNTY HEALTH CENTER
- Practice address
- 131 E Sullivan St
Spalding, NE 68665-6203 - Phone
- (308) 497-2485
- Fax
- (308) 497-2264
- NPI assigned
- Jul 10, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- BOONE COUNTY HEALTH CENTER
Authorized official
- Name
- Caleb K Poore
- Title
- Ceo
- Phone
- (402) 395-3213
Owners & managing parties with NPI records 1
-
Bridgette L. Pudwill, M.D.
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 10
Related certifications (CCN) 1
Practitioners 32
-
Tami S Dodds, MD
-
Laura D Klassen, PA-C
-
Sean R. Kohl, MD
-
Danielle M Krohn, APRN
-
Anthony P Kusek, MD
-
Tara S Leetch, APRN
-
Sara Dawn Mahony, PA-C
-
Carissa Mangus, MD
-
John F Mazour, MD
-
Amy L Olnes, APRN
-
Jason James Olnes, PA-C
-
Bridgette L. Pudwill, M.D.
-
Kelli M Ray, PA-C
-
Courtney S Ruzek, PA-C
-
Candice M Schnoor, DNP, APRN, FNP-C
-
Shannon M Stuhlmiller, PA-C
-
Joel A Travis, MD
-
Lynette D Kramer, MD
-
Lindsay Rae Groff, PA-C
-
Ashley Johnson, PA-C
-
Brett Van Kettelhut, M.D.
-
Kirk A. Kinberg, M.D.
-
Roger Hiro Kobayashi, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0455490 | Spalding Medical Clinic | Certificate of waiver | Apr 30, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Rural health clinic certification: CCN 283481
- Legal name
- BOONE COUNTY HEALTH CENTER
- Doing business as
- SPALDING MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 1, 2004
- Last certification
- Mar 24, 2025
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 131 E Sullivan St
Spalding, NE 68665-6203 - Related CCNs
- 281334
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Tony Kurtenbach |
Corporate Director | Jul 1, 2019 | |
| Dana J Cox |
Corporate Officer | Aug 2, 2024 | |
| Corporate Director | Jul 1, 2024 | ||
| Caleb Poore |
Corporate Officer |
Oct 16, 2023 | |
| W-2 Managing Employee |
Oct 16, 2023 | ||
| Operational/Managerial Control |
Oct 16, 2023 | ||
| Kim Beierman |
Corporate Officer | Oct 26, 2021 | |
| Corporate Director | Jul 1, 2015 | ||
| Paul Groeteke |
Corporate Officer | Oct 25, 2016 | |
| Corporate Director | Jul 1, 2015 | ||
| Gary Stokes |
Corporate Director | Jul 1, 2025 | |
| Bridgette L Pudwill |
W-2 Managing Employee |
Sep 1, 2019 | |
| Operational/Managerial Control |
Sep 1, 2019 | ||
| Kristie L Stricklin |
W-2 Managing Employee |
Jul 12, 2019 | |
| Operational/Managerial Control |
Jul 12, 2019 | ||
| Rita a Liss |
W-2 Managing Employee |
Jul 1, 2017 | |
| Operational/Managerial Control |
Jul 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041020001262 | NE | Part a Provider - Rural Health Clinic | 1254306178 | Practice locations: Spalding, NE |
National Provider Directory
- Tax ID family
- Laboratory Services
- Part of
- Laboratory Services
Locations
723 W Fairview St
#151
Albion, NE 68620
Phone (402) 395-2191
1019 S 8th St
#350
Albion, NE 68620
104 N 1st St
#400
Newman Grove, NE 68758
104 N 1st St
Newman Grove, NE 68758
Phone (402) 447-6214
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
131 E Sullivan St
Spalding, NE 68665-6203
Mailing address
PO Box 151
Albion, NE 68620-0151
Phone (402) 395-3213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025177700 | Medicaid | NE |
Other names
- Spalding Medical Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | BCHCHOSPITAL@boonecohealth.cernerdirect.com |
Other providers in Spalding, NE
- Caring Hearts Home Care, LLC
- City of Spalding
- Friendly Neighbor Healthcare, LLC
- Heritage of Spalding Inc
- Connie Kleffner
All providers in Spalding, NE · Rural Health Clinic/Center in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2024. 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.