NPIMap

Organization Active NPI

Kimball County Hospital

Doing business as Pine Bluffs KHS Health Clinic

  • Rural Health Clinic/Center
  • Pine Bluffs, WY
National Provider Identifier
1629524335
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KIMBALL COUNTY HOSPITAL
Doing business as
Pine Bluffs KHS Health Clinic
Practice address
117 E 4TH St
Pine Bluffs, WY 82082-5000
Phone
(307) 245-3666
Fax
(307) 245-3656
NPI assigned
Sep 1, 2016
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KIMBALL COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Cassie Gasseling
Title
Ceo
Phone
(308) 235-1951

Specialties & licenses 1

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

Addresses

Primary practice location

117 E 4TH St
Pine Bluffs, WY 82082-5000

Mailing address

255 W 4TH St
Kimball, NE 69145-1706
Phone (308) 235-1951

Other names 1

  • Pine Bluffs KHS Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, WY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070222000526 NE Part A Provider - Critical Access Hospital 5799751004 Receives reassigned benefits from 32 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kimball, NE
O20161202000661 WY Part A Provider - Rural Health Clinic 5799751004 Practice locations: Pine Bluffs, WY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1629524335. Details of each certification follow.

Hospital certification: CCN 281305

Legal name
KIMBALL COUNTY HOSPITAL
Doing business as
KIMBALL HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 1999
Last certification
Oct 9, 2024
Beds
14
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
255 W 4TH St
Kimball, NE 69145-1706
Main/Primary Hospital Location

Rural health clinic certification: CCN 533990

Legal name
KIMBALL COUNTY HOSPITAL
Doing business as
PINE BLUFFS KHS HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 27, 2017
Last certification
Jul 2, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
117 E 4TH St
Pine Bluffs, WY 82082-5000
Related CCNs
281305

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

Other NPIs with the same Medicare PAC ID 3

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
Kimball Health ServicesCCN 281305 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
53D2121114Kimball County Hospital117 East 4TH Street, Pine Bluffs, WY 82082Certificate of waiverOct 30, 2026

National Provider Directory

National Provider Directory
Part of
Kimball County Hospital

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jerome Knutsen Individual Corporate Director Jan 5, 2010
Trevor W Bush Individual W-2 Managing EmployeeChief of Staff Sep 20, 2023
Operational/Managerial ControlChief of Staff Sep 20, 2023
W-2 Managing EmployeeMedical Director Sep 20, 2023
Operational/Managerial ControlMedical Director Sep 20, 2023
Karen L Morrison Individual Corporate Officer Aug 7, 2023
Corporate Director Jan 30, 2012
Kimball County Hospital Organization, Kimball, NE 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Kayla Fennell Individual Corporate Officer Apr 28, 2022
Corporate Director Apr 28, 2022
Corporate Officer Jan 26, 2026
Cassie Gasseling Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Aug 9, 2019
Operational/Managerial ControlCeo Aug 9, 2019
James a Cederburg Individual Corporate Officer Sep 14, 2010
Corporate Director Sep 14, 2010
Taryn Reader Individual Corporate Director Jan 26, 2026
Stevie Webb Individual W-2 Managing EmployeeCoo/Cno May 23, 2022
Operational/Managerial ControlCoo/Cno May 23, 2022

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Kimball Health ServicesKimball, NE, CCN 281305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Kimball Health ServicesKimball, NE, CCN 28Z305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Kimball Health Services ClinicKimball, NE, CCN 283437 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

Affiliated clinicians 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1629524335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W 4TH ST",
            "city": "KIMBALL",
            "state": "NE",
            "postal_code": "691451706",
            "telephone_number": "308-235-1951",
            "fax_number": "308-235-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E 4TH ST",
            "city": "PINE BLUFFS",
            "state": "WY",
            "postal_code": "820825000",
            "telephone_number": "307-245-3666",
            "fax_number": "307-245-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBALL COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIMBALL COUNTY HOSPITAL",
        "enumeration_date": "2016-09-01",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "GASSELING",
        "authorized_official_first_name": "CASSIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-235-1951"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Bluffs KHS Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pine Bluffs KHS Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluffs, WY

Sources for this page

Verify at the official NPI Registry.