NPIMap

Organization Active NPI

Crete Area Medical Center

Doing business as Friend Medical Clinic

  • Rural Health Clinic/Center
  • Friend, NE
National Provider Identifier
1699217588
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRETE AREA MEDICAL CENTER
Doing business as
Friend Medical Clinic
Practice address
1210 2ND St
Friend, NE 68359-1116
Phone
(402) 947-2021
Fax
(402) 947-2127
NPI assigned
Nov 9, 2016
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CRETE AREA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Julie Lacy
Title
President & Ceo
Phone
(402) 826-2102

Specialties & licenses 1

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

Addresses

Primary practice location

1210 2ND St
Friend, NE 68359-1116

Mailing address

PO Box 860873
Minneapolis, MN 55486-0873
Phone (402) 826-2102

Other names 1

  • FRIEND MEDICAL CLINIC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@hisp.bryanhealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170425000321 NE Part A Provider - Rural Health Clinic 4385556216 Practice locations: Friend, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699217588. Details of each certification follow.

Rural health clinic certification: CCN 288545

Legal name
CRETE AREA MEDICAL CENTER
Doing business as
FRIEND MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 14, 2003
Last certification
Nov 16, 2022
Ownership / control type
2B
Most recent change of ownership
Jun 1, 2017 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 2001 in NE
Enrollment address
1210 2ND St
Friend, NE 68359-1116
Related CCNs
281354

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

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Crete Area Medical Cent6 organizations share this tax ID, including this one
Part of
Crete Area Medical Cent

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Michael J Kozisek Individual Corporate Officer Jan 1, 2024
Corporate Director Jan 1, 2023
Maria Isquierdo Individual Corporate Director Jan 1, 2022
Jason K Hesser Individual Corporate Director Jan 1, 2023
Eric S Post Individual Corporate Officer Jan 1, 2024
Corporate Director Jan 1, 2023
Ryan J Buse Individual W-2 Managing EmployeeMD; Sep 3, 2021
Operational/Managerial ControlMedical Director Sep 3, 2021
Patrick D Ganyo Individual Corporate Director Jul 1, 2024
Bryan Health Organization, Lincoln, NE Corporation, Non-profit, Chain home office Operational/Managerial Control Feb 1, 2002
Julie Lacy Individual Corporate OfficerPresident & Ceo Jul 1, 2024
Corporate DirectorPresident & Ceo Jul 1, 2024
W-2 Managing EmployeePresident & Ceo Jul 1, 2024
Operational/Managerial ControlPresident & Ceo Jul 1, 2024
David K Newmyer Individual Corporate Director Jan 1, 2024
Guadalupe C Avelar Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2020
Stephanie R Hollman Individual W-2 Managing EmployeeClinic Operations Director Apr 12, 2010
Operational/Managerial ControlClinic Operations Director Apr 12, 2010

Owners & managing parties with NPI records 2

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

Facilities with the same owner 17

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

View all 17

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 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1699217588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860873",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860873",
            "telephone_number": "402-826-2102",
            "fax_number": "402-826-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 2ND ST",
            "city": "FRIEND",
            "state": "NE",
            "postal_code": "683591116",
            "telephone_number": "402-947-2021",
            "fax_number": "402-947-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRETE AREA MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRETE AREA MEDICAL CENTER",
        "enumeration_date": "2016-11-09",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "402-826-2102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@hisp.bryanhealth.org",
            "affiliation": "N",
            "address_1": "1600 S 48th St",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685061299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "FRIEND MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FRIEND MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Friend, NE

Sources for this page

Verify at the official NPI Registry.