Active NPI
Ponca Tribe of Nebraska
- Clinic/Center
- Omaha, NE
National Provider Identifier
1710172879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- PONCA TRIBE OF NEBRASKA
- Practice address
- 2602 J St
Omaha, NE 68107-1643 - Phone
- (402) 733-3612
- Fax
- (402) 734-7156
- NPI assigned
- Sep 12, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen M Rieb
- Title
- Compliance Officer
- Phone
- (402) 315-2772
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Home Health Agency | 251E00000X | |||
| Nursing Care Agency | 251J00000X | |||
| Public Health or Welfare Agency | 251K00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Clinic/Center | 261Q00000X | Primary | ||
| Dental Clinic/Center | 261QD0000X | |||
| Physical Therapy Clinic/Center | 261QP2000X | |||
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 332800000X |
Addresses
Primary practice location
2602 J St
Omaha, NE 68107-1643
Mailing address
5805 S 86TH Cir
Omaha, NE 68127-4145
Phone (402) 315-2760
Other practice location 1
2528 Woodbine St
Niobrara, NE 68760-6111
Phone (402) 857-3391
Other practice location 2
125 6th St
Sioux City, IA 51103-4405
Phone (712) 258-0500
Other practice location 3
1701 E St
Lincoln, NE 68508-3429
Phone (402) 438-9222
Other practice location 4
1800 Syracuse Ave
Norfolk, NE 68701-2458
Phone (402) 371-8780
Other names 8
- Fred LeRoy Health & Wellness Center
- Ponca Behavioral Health Services
- Ponca Clinical Services
- Ponca Dental Services
- Ponca Health Services
- Ponca Hills Health & Wellness Center
- Ponca Pharmacy Services
- Ponca Population Health Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE, TX
Enrollment records 4
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190227000629 | NE | Part A Provider - Federally Qualified Health Center (FQHC) | 0648169177 | Practice locations: Omaha, NE |
| O20190311001784 | TX | Part B Supplier - Clinic/Group Practice | 0648169177 |
Receives reassigned benefits from 31 practitioners Practice locations: Lincoln, NE; Niobrara, NE; Norfolk, NE; Omaha, NE |
| O20190626003270 | TX | Part A Provider - Federally Qualified Health Center (FQHC) | 0648169177 | Practice locations: Norfolk, NE |
| O20230307003192 | TX | Part A Provider - Federally Qualified Health Center (FQHC) | 0648169177 | Practice locations: Lincoln, NE |
Federally qualified health center certification: CCN 281846
- Legal name
- PONCA TRIBE OF NEBRASKA
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 26, 2019
- Last certification
- Feb 26, 2019
- Ownership / control type
- Non-profit – other
- Organization structure
- Other
- Enrollment address
- 2602 J St
Omaha, NE 68107-1643
Federally qualified health center certification: CCN 281851
- Legal name
- PONCA TRIBE OF NEBRASKA
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 11, 2019
- Last certification
- Mar 11, 2019
- Ownership / control type
- Non-profit – other
- Organization structure
- Other
- Enrollment address
- 1800 Syracuse Ave
Norfolk, NE 68701-2458
Federally qualified health center certification: CCN 281081
- Legal name
- PONCA TRIBE OF NEBRASKA
- Doing business as
- PONCA HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 2, 2023
- Last certification
- Mar 2, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Other
- Incorporated
- Dec 1, 2021 in NE
- Enrollment address
- 1600 Windhoek Dr
Lincoln, NE 68512-1272
National Provider Directory
National Provider DirectoryLocations
125 6th St
Sioux City, IA 51103
Phone (712) 258-0500
2606 J St
Omaha, NE 68107
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ponca Tribe of Nebraska | Other | Jan 1, 2000 | 100% |
| Operational/Managerial Control | Oct 30, 2022 | 100% | |
| Rebecca Crase | Corporate Director | Sep 1, 2019 | |
| W-2 Managing Employee | Oct 1, 2020 | ||
| Corporate Director | Sep 1, 2019 | ||
| Corporate Director | Oct 30, 2022 | ||
| W-2 Managing Employee | Oct 30, 2022 | ||
| Operational/Managerial Control | Oct 30, 2022 |
Practitioners & affiliated clinicians
Practitioners 36
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189555200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1540166400000",
"number": "1710172879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5805 S 86TH CIR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681274145",
"telephone_number": "402-315-2760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2602 J ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681071643",
"telephone_number": "402-733-3612",
"fax_number": "402-734-7156"
}
],
"practiceLocations": [
{
"address_1": "2528 Woodbine St",
"address_purpose": "LOCATION",
"city": "Niobrara",
"state": "NE",
"postal_code": "687606111",
"country_code": "US",
"telephone_number": "402-857-3391",
"fax_number": "402-857-3736",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "125 6th St",
"address_purpose": "LOCATION",
"city": "Sioux City",
"state": "IA",
"postal_code": "511034405",
"country_code": "US",
"telephone_number": "712-258-0500",
"fax_number": "712-258-0762",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1701 E St",
"address_purpose": "LOCATION",
"city": "Lincoln",
"state": "NE",
"postal_code": "685083429",
"country_code": "US",
"telephone_number": "402-438-9222",
"fax_number": "402-438-9226",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1800 Syracuse Ave",
"address_purpose": "LOCATION",
"city": "Norfolk",
"state": "NE",
"postal_code": "687012458",
"country_code": "US",
"telephone_number": "402-371-8780",
"fax_number": "402-379-4293",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PONCA TRIBE OF NEBRASKA",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-12",
"last_updated": "2018-10-22",
"status": "A",
"authorized_official_last_name": "RIEB",
"authorized_official_first_name": "KATHLEEN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "COMPLIANCE OFFICER",
"authorized_official_telephone_number": "402-315-2772"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": null,
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": false
},
{
"code": "332800000X",
"taxonomy_group": "",
"desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fred LeRoy Health & Wellness Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Behavioral Health Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Clinical Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Dental Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Health Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Hills Health & Wellness Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Pharmacy Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Ponca Population Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.