Osmond General Hospital Inc
Organization Active NPI Family Medicine Physician · Wausa, NE
NPI 1700979622 · NPPES record last updated Apr 27, 2026
Key facts
- NPI
- 1700979622
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- OSMOND GENERAL HOSPITAL INC
- Practice address
- 100 N Lincoln St
Wausa, NE 68786-2050 - Phone
- (402) 586-2244
- Fax
- (402) 586-2580
- NPI assigned
- Oct 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- OSMOND GENERAL HOSPITAL INC
Authorized official
- Name
- Tiffany J Rice
- Title
- Interim Ceo
- Phone
- (402) 748-3393
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 2
-
Kelly Leigh Bullock, D.O.
-
Kevin D. Lauck, PA-C
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Practitioners 8
-
Tiffany Jo Rice, APRN
-
Bobbie Jo Marie Miller, APRN
-
Kelly Leigh Bullock, D.O.
-
Samantha Kay Kizzire, APRN
-
Thomas M Beutler, MD
-
Alicia Anne Vandewalle, APRN
-
Katelyn Marie Anderson, MSW, CSW-PIP, QMHP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0455699 | Wausa Medical Clinic | Certificate of waiver | Jul 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Rural health clinic certification: CCN 288534
- Legal name
- OSMOND GENERAL HOSPITAL INC
- Doing business as
- WAUSA MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 11, 2015
- Last certification
- Mar 18, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 29, 1971 in NE
- Enrollment address
- 100 N Lincoln St
Wausa, NE 68786-2050 - Related CCNs
- 281347
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Douglas a Koehler |
Corporate Director | Jan 27, 2020 | |
| Douglas Ketelsen |
Corporate Officer | Mar 24, 2014 | |
| Corporate Director | Jun 19, 2001 | ||
| Stephanie K Anderson |
Corporate Director | May 23, 2022 | |
| Timothy Kint |
Corporate Officer | Mar 24, 2014 | |
| Corporate Director | Jan 10, 1998 | ||
| Kelly L Bullock |
W-2 Managing Employee |
Jul 1, 2019 | |
| Operational/Managerial Control |
Jul 1, 2019 | ||
| Walter J Aschoff |
Corporate Director | Jun 30, 2014 | |
| Kevin D Lauck |
Corporate Director | Jun 30, 2014 | |
| William G Hefner |
Corporate Director | Aug 29, 2022 | |
| Jodi Aschoff |
W-2 Managing Employee |
Dec 31, 2000 | |
| Operational/Managerial Control |
Dec 31, 2000 | ||
| Theresa Stapelman |
Corporate Officer | Apr 24, 2017 | |
| Corporate Director | Apr 21, 1998 | ||
| Lon Knievel |
Corporate Director |
Apr 22, 2015 | |
| W-2 Managing Employee |
Jul 13, 2015 | ||
| Operational/Managerial Control |
Apr 22, 2015 | ||
| Nichole Aitken |
W-2 Managing Employee |
Jan 8, 2018 | |
| Operational/Managerial Control |
Jan 8, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041130000809 | NE | Part B Supplier - Clinic/Group Practice | 4183689227 |
Receives reassigned benefits from 13 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Osmond, NE |
| O20141218001811 | NE | Part a Provider - Rural Health Clinic | 4183689227 | Practice locations: Wausa, NE |
National Provider Directory
- Tax ID family
- Osmond General Hospital
- Part of
- Osmond General Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Physician Assistant |
363A00000X |
Addresses
Primary practice location
100 N Lincoln St
Wausa, NE 68786-2050
Mailing address
PO Box 429
Osmond, NE 68765-0429
Phone (402) 748-3393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 822554 | Other | NE | WAUSA (COVENTRY) |
Other names
- Wausa Medical Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | osmond.clinic@osmond-gpha.cernerdirect.com | Direct |
NPI Registry JSON
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1777248000000",
"number": "1700979622",
"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": "100 N LINCOLN ST",
"city": "WAUSA",
"state": "NE",
"postal_code": "687862050",
"telephone_number": "402-586-2244",
"fax_number": "402-586-2580"
}
],
"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": "WAUSA (COVENTRY)",
"identifier": "822554",
"state": "NE"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "osmond.clinic@osmond-gpha.cernerdirect.com",
"affiliation": "N",
"endpointDescription": "Wausa Medical Clinic",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "100 N Lincoln St",
"city": "Wausa",
"state": "NE",
"country_code": "US",
"postal_code": "687862050",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Wausa Medical Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Wausa Medical Clinic",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.