NPIMap

Organization Active NPI

Avera St Anthonys Hospital

Doing business as Avera Medical Group Spencer

  • Rural Health Clinic/Center
  • Spencer, NE
National Provider Identifier
1629344692
Registry record updated May 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AVERA ST ANTHONYS HOSPITAL
Doing business as
Avera Medical Group Spencer
Practice address
103 S Thayer St
Spencer, NE 68777-9784
Phone
(402) 589-1328
NPI assigned
Mar 23, 2012
Last updated
May 1, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
AVERA ST ANTHONYS HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2012

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

Authorized official

Name
Ronald J. Cork
Title
President/Ceo
Phone
(402) 336-2611

Specialties & licenses 1

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

Addresses

Primary practice location

103 S Thayer St
Spencer, NE 68777-9784

Mailing address

PO Box 270
Oneill, NE 68763-0270
Phone (402) 336-2900

Other names 1

  • Avera Medical Group Spencer Doing business as

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
28D2040591Avera Medical Group Spencer103 South Thayer Street, Spencer, NE 68777Certificate of waiverMay 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Anthonys Hosp Card Dep8 organizations share this tax ID, including this one
Part of
St Anthonys Hosp Card Dep

Other organizations with this tax ID 7

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

Locations

209 E Benton St
Oneill, NE 68763

Ownership & related parties

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 & affiliated clinicians

Practitioners 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1629344692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "ONEILL",
            "state": "NE",
            "postal_code": "687630270",
            "telephone_number": "402-336-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S THAYER ST",
            "city": "SPENCER",
            "state": "NE",
            "postal_code": "687779784",
            "telephone_number": "402-589-1328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST ANTHONYS HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA ST ANTHONYS HOSPITAL",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "CORK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "402-336-2611"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Spencer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spencer, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.