NPIMap

Organization Active NPI

Providence Medical Center

Doing business as Providence Medical Center Clinic

  • Primary Care Clinic/Center
  • Wayne, NE
National Provider Identifier
1699556647
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROVIDENCE MEDICAL CENTER
Doing business as
Providence Medical Center Clinic
Practice address
1200 Providence Rd
Wayne, NE 68787-1212
Phone
(402) 375-3800
Fax
(402) 375-7610
NPI assigned
Oct 6, 2023
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Danielle Gearhart
Title
Ceo
Phone
(402) 375-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

1200 Providence Rd
Wayne, NE 68787-1212

Mailing address

1200 Providence Rd
Wayne, NE 68787-1212
Phone (402) 375-3800

Other names 1

  • Providence Medical Center Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041124000342 NE Part B Supplier - Clinic/Group Practice 4587629928 Receives reassigned benefits from 56 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wayne, NE

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Providence Med Center6 organizations share this tax ID, including this one
Part of
Providence Med Center

Other organizations with this tax ID 5

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

Locations

699 Cedar Ave
Laurel, NE 68745
Phone (402) 256-7637

308 Ash St
Wakefield, NE 68784
Phone (402) 287-1005

803 Providence Rd
Ste 103
Wayne, NE 68787
Phone (402) 375-4288

Practitioners & affiliated clinicians

Practitioners 55

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 55

NPI Registry JSON

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1699556647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 PROVIDENCE RD",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871212",
            "telephone_number": "402-375-3800",
            "fax_number": "402-375-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 PROVIDENCE RD",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871212",
            "telephone_number": "402-375-3800",
            "fax_number": "402-375-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE MEDICAL CENTER",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "GEARHART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-375-3800"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.