NPIMap

Organization Active NPI

Osmond General Hospital Inc

  • Family Medicine Physician
  • Randolph, NE
National Provider Identifier
1700979614
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OSMOND GENERAL HOSPITAL INC
Practice address
106 E Wayne St
Randolph, NE 68771-5300
Phone
(402) 337-0200
Fax
(402) 337-1020
NPI assigned
Oct 2, 2006
Organization subpart
Yes
Parent organization
OSMOND GENERAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Tiffany J RiceNPI 1336025626
Title
Interim Ceo
Phone
(402) 748-3393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

106 E Wayne St
Randolph, NE 68771-5300

Mailing address

PO Box 429
Osmond, NE 68765-0429
Phone (402) 748-3393

Other identifiers 1

IdentifierTypeStateIssuer
2131672OtherNERANDOLPH (COVENTRY)

Other names 1

  • Randolph Family Practice Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address osmond.clinic@osmond-gpha.cernerdirect.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041130000809 NE Part B Supplier - Clinic/Group Practice 4183689227 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
Practice locations: Osmond, NE
O20141212002144 NE Part A Provider - Rural Health Clinic 4183689227 Practice locations: Randolph, NE

Rural health clinic certification: CCN 288533

Legal name
OSMOND GENERAL HOSPITAL INC
Doing business as
RANDOLPH FAMILY PRACTICE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 12, 2015
Last certification
Apr 24, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1971 in NE
Enrollment address
106 E Wayne St
Randolph, NE 68771-5300
Related CCNs
281347

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).

Other NPIs on the same Medicare enrollment 3

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

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
28D0455661Randolph Family Practice106 E Wayne Street, Randolph, NE 68771Certificate of waiverOct 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Osmond General Hospital5 organizations share this tax ID, including this one
Part of
Osmond General Hospital

Other organizations with this tax ID 4

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

Interoperability endpoints

  • Direct secure messaging: osmond.clinic@osmond-gpha.cernerdirect.com

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Douglas a Koehler Individual Corporate Director Jan 27, 2020
Douglas Ketelsen Individual Corporate Officer Mar 24, 2014
Corporate Director Jun 19, 2001
Stephanie K Anderson Individual Corporate Director May 23, 2022
Timothy Kint Individual Corporate Officer Mar 24, 2014
Corporate Director Jan 10, 1998
Kelly L Bullock Individual W-2 Managing EmployeeMedical Director Jul 1, 2019
Operational/Managerial ControlMedical Director Jul 1, 2019
Walter J Aschoff Individual Corporate Director Jun 30, 2014
Kevin D Lauck Individual Corporate Director Jun 30, 2014
William G Hefner Individual Corporate Director Aug 29, 2022
Jodi Aschoff Individual W-2 Managing EmployeeCfo Dec 31, 2000
Operational/Managerial ControlCfo Dec 31, 2000
Theresa Stapelman Individual Corporate Officer Apr 24, 2017
Corporate Director Apr 21, 1998
Lon Knievel Individual Corporate DirectorCeo Apr 22, 2015
W-2 Managing EmployeeCeo Jul 13, 2015
Operational/Managerial ControlCeo Apr 22, 2015
Nichole Aitken Individual W-2 Managing EmployeeClinic Director Jan 8, 2018
Operational/Managerial ControlClinic Director Jan 8, 2018

Owners & managing parties with NPI records 2

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

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1700979614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "OSMOND",
            "state": "NE",
            "postal_code": "687650429",
            "telephone_number": "402-748-3393",
            "fax_number": "402-748-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E WAYNE ST",
            "city": "RANDOLPH",
            "state": "NE",
            "postal_code": "687715300",
            "telephone_number": "402-337-0200",
            "fax_number": "402-337-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSMOND GENERAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OSMOND GENERAL HOSPITAL INC",
        "enumeration_date": "2006-10-02",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "402-748-3393"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RANDOLPH (COVENTRY)",
            "identifier": "2131672",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "osmond.clinic@osmond-gpha.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Randolph Family Practice Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "106 E Wayne St",
            "city": "Randolph",
            "state": "NE",
            "country_code": "US",
            "postal_code": "687715300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Randolph Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Randolph Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Randolph, NE

Sources for this page

Verify at the official NPI Registry.