NPIMap

Organization Active NPI

Stuart Village Nursing Home Board Parkside Manor of Stuart

Doing business as Parkside Manor

  • Skilled Nursing Facility
  • Stuart, NE
National Provider Identifier
1659337475
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
414003 Issued in NE
Legal business name
STUART VILLAGE NURSING HOME BOARD PARKSIDE MANOR OF STUART
Doing business as
Parkside Manor
Practice address
507 N Main St
Stuart, NE 68780-1721
Phone
(402) 924-3601
Fax
(402) 924-3615
NPI assigned
Apr 21, 2006
Last updated
Aug 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Authorized official

Name
Mr. Lucas A Kaup
Title
Administrator
Phone
(402) 924-3601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 414003 NE Primary

Addresses

Primary practice location

507 N Main St
Stuart, NE 68780-1721

Mailing address

PO Box 350
Stuart, NE 68780-0350
Phone (402) 924-3601

Other names 1

  • Parkside Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000803 NE Part A Provider - Skilled Nursing Facility 4688565252 Practice locations: Stuart, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659337475. Details of each certification follow.

Skilled nursing facility certification: CCN 285245

Legal name
STUART VILLAGE NURSING HOME BOARD PARKSIDE MANOR OF STUART
Doing business as
PARKSIDE MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 2002
Last certification
Feb 20, 2025
Beds
40
Ownership / control type
City
Organization structure
OtherNon-profit
Enrollment address
607 N Main St
Stuart, NE 68780-1822
Nursing home name
PARKSIDE MANOR
Affiliated entity
RURAL HEALTH DEVELOPMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Parkside ManorCCN 285245 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - City
Certified
Apr 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4027.5 residents per day on average
Chain
Rural Health Development9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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
28D0888255Parkside Manor607 North Main Street, Stuart, NE 68780Certificate of waiverJun 27, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Evelyn Paxton Individual Corporate Director May 1, 2010 20%
Managing Control - Governing Body May 1, 2010
Trustee of the SNF May 1, 2010
Connie Weichman Individual Managing Control - Governing Body May 24, 2022
Trustee of the SNF May 24, 2022
Lucas a Kaup Individual Operational/Managerial Control Aug 15, 2013
Adp of the SNF Feb 12, 2025
John D Tubbs Individual Operational/Managerial Control Jan 1, 2013
Adp of the SNF Jan 1, 2013
Amgl, P.C Organization, Grand Island, NE Corporation, For-profit Adp of the SNF Apr 25, 2025
Indirect Ownership Interest Jan 1, 2024
Rural Health Development Inc. Organization, Cambridge, NE Corporation, For-profit Operational/Managerial Control Feb 1, 1995
Adp of the SNF Feb 12, 2025
Village of Stuart Organization, Stuart, NE 5% Or Greater Direct Ownership Interest Jul 1, 1971 100%
Trustee of the SNF Jul 1, 1971
Adp of the SNF Jul 1, 1971
Donald Schmaderer Individual Corporate Director May 15, 1985 20%
Managing Control - Governing Body May 15, 1985
Trustee of the SNF May 15, 1985
James Chvala Individual Managing Control - Governing Body May 1, 2002
Trustee of the SNF May 1, 2002
Louise Cadwallader Individual Corporate Director Dec 15, 1997 20%
Managing Control - Governing BodyBoard Member Dec 15, 1997
Trustee of the SNF Dec 15, 1997

Owners & managing parties with NPI records 1

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377648000000",
    "number": "1659337475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 350",
            "city": "STUART",
            "state": "NE",
            "postal_code": "687800350",
            "telephone_number": "402-924-3601",
            "fax_number": "402-924-3615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 N MAIN ST",
            "city": "STUART",
            "state": "NE",
            "postal_code": "687801721",
            "telephone_number": "402-924-3601",
            "fax_number": "402-924-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUART VILLAGE NURSING HOME BOARD PARKSIDE MANOR OF STUART",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2013-08-28",
        "status": "A",
        "authorized_official_last_name": "KAUP",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "402-924-3601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "414003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stuart, NE

Sources for this page

Verify at the official NPI Registry.