NPIMap

Organization Active NPI

Brodstone Memorial Hospital

Doing business as Brodstone Healthcare

  • Medicare Defined Swing Bed Hospital Unit
  • Superior, NE
National Provider Identifier
1699855023
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
570001 Issued in NE
Legal business name
BRODSTONE MEMORIAL HOSPITAL
Doing business as
Brodstone Healthcare
Brodstone Memorial Hospital
Practice address
520 E 10TH St
Superior, NE 68978-1225
Phone
(402) 879-3281
Fax
(402) 879-3401
NPI assigned
Oct 17, 2006
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BRODSTONE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 570001 NE Primary

Addresses

Primary practice location

520 E 10TH St
Superior, NE 68978-1225

Mailing address

PO Box 187
Superior, NE 68978-0187
Phone (402) 879-3281

Other names 2

  • BRODSTONE HEALTHCARE Doing business as
  • BRODSTONE MEMORIAL HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071108000013 NE Part A Provider - Critical Access Hospital 4082513015 Practice locations: Superior, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699855023. Details of each certification follow.

Hospital certification: CCN 28Z315

Legal name
BRODSTONE MEMORIAL HOSPITAL
Doing business as
BRODSTONE HEALTHCARE
Organization structure
CorporationNon-profit
Incorporated
Sep 24, 1926 in NE
Enrollment address
520 E 10TH St
Superior, NE 68978-1225

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Brodstone Mem Nuckolls Co3 organizations share this tax ID, including this one
Part of
Brodstone Mem Nuckolls Co

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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
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 EmployeeChief of Staff May 17, 2024
Operational/Managerial ControlChief of Staff May 17, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1699855023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689780187",
            "telephone_number": "402-879-3281",
            "fax_number": "402-879-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E 10TH ST",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689781225",
            "telephone_number": "402-879-3281",
            "fax_number": "402-879-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRODSTONE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRODSTONE MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-17",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NE",
            "license": "570001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRODSTONE HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRODSTONE MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, NE

Sources for this page

Verify at the official NPI Registry.