NPIMap

Organization Active NPI

Brodstone Memorial Hospital

  • Rural Health Clinic/Center
  • Edgar, NE
National Provider Identifier
1699746248
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRODSTONE MEMORIAL HOSPITAL
Practice address
315 N C St
Edgar, NE 68935-3194
Phone
(402) 224-3344
Fax
(402) 224-3346
NPI assigned
Jan 31, 2006
Organization subpart
Yes
Parent organization
BRODSTONE MEMORIAL HOSPITALAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Treg Vyzourek
Title
Ceo
Phone
(402) 879-3281

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 4

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

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

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
28D0948021Brodstone Family Medical Center - Edgar315 North C Street, Edgar, NE 68935Certificate of waiverJun 29, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Rural health clinic certification: CCN 283496

Medicare enrollment files
Legal name
BRODSTONE MEMORIAL HOSPITAL
Doing business as
BRODSTONE FAMILY MEDICAL CENTER - EDGAR
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2006
Last certification
Dec 15, 2025
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2017 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
315 N C St
Edgar, NE 68935-3194
Related CCNs
281315

All disclosed owners & managing parties 9

Medicare enrollment files

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

NameRoleSinceShare
Janet L Eggers Individual Corporate Officer Sep 24, 2018
Corporate Director May 22, 2017
Treg Vyzourek Individual Corporate OfficerCeo Jan 22, 2018
W-2 Managing EmployeeCeo Jan 22, 2018
Operational/Managerial ControlCeo Jan 22, 2018
Royce L Schott Individual Corporate Officer May 28, 2024
Corporate Director May 31, 2022
Piper a Hodge Individual Corporate Officer May 30, 2023
Corporate Director May 30, 2023
Judy a Baker Individual W-2 Managing EmployeeAd;Clinic Director Oct 1, 2002
Operational/Managerial ControlClinic Director Oct 1, 2002
Sandra Borden Individual Corporate Director May 28, 2024
Beth Siebecker Individual Corporate Officer May 25, 2021
Corporate Director Jul 30, 2018
Jacqueline Porter Individual Corporate Director May 23, 2016
Timothy D Blecha Individual W-2 Managing EmployeeMD; Jul 1, 2017
Operational/Managerial ControlMedical Director Jul 1, 2017

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040423000949 NE Part B Supplier - Clinic/Group Practice 4082513015 Receives reassigned benefits from 27 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deshler, NE; Superior, NE
O20170612001904 NE Part a Provider - Rural Health Clinic 4082513015 Practice locations: Edgar, NE

National Provider Directory

National Provider Directory
Part of
Brodstone Memorial Hospital

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

NPPES NPI Registry

Primary practice location

315 N C St
Edgar, NE 68935-3194

Mailing address

PO Box 407
Superior, NE 68978-0407
Phone (402) 879-4781

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
10025359800MedicaidNE
10025288500MedicaidNE

Other names 2

NPPES NPI Registry
  • BRODSTONE FAMILY MEDICAL CENTER - EDGAR Doing business as
  • EDGAR MEDICAL CLINIC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 23, 2022.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1699746248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 407",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689780407",
            "telephone_number": "402-879-4781",
            "fax_number": "402-879-3365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N C ST",
            "city": "EDGAR",
            "state": "NE",
            "postal_code": "689353194",
            "telephone_number": "402-224-3344",
            "fax_number": "402-224-3346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRODSTONE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRODSTONE MEMORIAL HOSPITAL",
        "enumeration_date": "2006-01-31",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "VYZOUREK",
        "authorized_official_first_name": "TREG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-879-3281"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025359800",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025288500",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRODSTONE FAMILY MEDICAL CENTER - EDGAR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EDGAR MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgar, NE

Sources for this page

Verify at the official NPI Registry.