NPIMap

Organization Active NPI

Central Nebraska Medical Clinic PC

  • Family Medicine Physician
  • Broken Bow, NE
National Provider Identifier
1578668232
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRAL NEBRASKA MEDICAL CLINIC PC
Practice address
145 Memorial Drive
Broken Bow, NE 68822
Phone
(308) 872-2486
Fax
(308) 872-2026
NPI assigned
Sep 14, 2006
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
David A Minnick, MDNPI 1891897997
Title
Owner Partner
Phone
(308) 872-2486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

145 Memorial Drive
Broken Bow, NE 68822

Mailing address

PO Box 690
Broken Bow, NE 68822
Phone (308) 872-2486

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000695 NE Part B Supplier - Clinic/Group Practice 4486640265 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
Practice locations: Broken Bow, NE

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

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1578668232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "68822",
            "telephone_number": "308-872-2486",
            "fax_number": "308-872-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MEMORIAL DRIVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "68822",
            "telephone_number": "308-872-2486",
            "fax_number": "308-872-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL NEBRASKA MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "MINNICK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "308-872-2486",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Bow, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.