NPIMap

Organization Active NPI

Boone County Health Center

Doing business as Nance County Medical Clinic

  • Rural Health Clinic/Center
  • Fullerton, NE
National Provider Identifier
1730113150
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOONE COUNTY HEALTH CENTER
Doing business as
Nance County Medical Clinic
Practice address
405 Broadway St
Fullerton, NE 68638-3155
Phone
(308) 536-2446
Fax
(308) 536-2727
NPI assigned
Jul 10, 2006
Last updated
Apr 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BOONE COUNTY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Authorized official

Name
Caleb K Poore
Title
Ceo
Phone
(402) 395-3213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

405 Broadway St
Fullerton, NE 68638-3155

Mailing address

PO Box 151
Albion, NE 68620-0151
Phone (402) 395-3213

Other names 1

  • Nance County Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BCHCHOSPITAL@boonecohealth.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908000568 NE Part A Provider - Rural Health Clinic 1254306178 Practice locations: Fullerton, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730113150. Details of each certification follow.

Rural health clinic certification: CCN 283458

Legal name
BOONE COUNTY HEALTH CENTER
Doing business as
NANCE COUNTY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2002
Last certification
Jan 7, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
405 Broadway St
Fullerton, NE 68638-3155
Related CCNs
281334

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

Other NPIs with the same Medicare PAC ID 8

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

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
28D0877347Nance County Medical Clinic405 Broadway Street, Fullerton, NE 68638ComplianceAug 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Laboratory Services11 organizations share this tax ID, including this one
Part of
Laboratory Services

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Tony Kurtenbach Individual Corporate Director Jul 1, 2019
Dana J Cox Individual Corporate Officer Aug 2, 2024
Corporate Director Jul 1, 2024
Caleb Poore Individual Corporate OfficerCeo Oct 16, 2023
W-2 Managing EmployeeCeo Oct 16, 2023
Operational/Managerial ControlCeo Oct 16, 2023
Kim Beierman Individual Corporate Officer Oct 26, 2021
Corporate Director Jul 1, 2015
Paul Groeteke Individual Corporate Officer Oct 25, 2016
Corporate Director Jul 1, 2015
Gary Stokes Individual Corporate Director Jul 1, 2025
Sean R Kohl Individual W-2 Managing EmployeeMD; Apr 1, 2014
Operational/Managerial ControlMedical Director Apr 1, 2014
Kristie L Stricklin Individual W-2 Managing EmployeeAd;VP of Clinic Services Jul 12, 2019
Operational/Managerial ControlVP of Clinic Services Jul 12, 2019
Rita a Liss Individual W-2 Managing EmployeeCfo Jul 1, 2017
Operational/Managerial ControlCfo Jul 1, 2017

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1730113150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151",
            "city": "ALBION",
            "state": "NE",
            "postal_code": "686200151",
            "telephone_number": "402-395-3213",
            "fax_number": "402-395-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BROADWAY ST",
            "city": "FULLERTON",
            "state": "NE",
            "postal_code": "686383155",
            "telephone_number": "308-536-2446",
            "fax_number": "308-536-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE COUNTY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOONE COUNTY HEALTH CENTER",
        "enumeration_date": "2006-07-10",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "POORE",
        "authorized_official_first_name": "CALEB",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-395-3213"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BCHCHOSPITAL@boonecohealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "723 W Fairview St",
            "city": "Albion",
            "state": "NE",
            "country_code": "US",
            "postal_code": "686201725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nance County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nance County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, NE

Sources for this page

Verify at the official NPI Registry.