NPIMap

Organization Active NPI

Midtown Health Center, Inc.

Doing business as Midtown Health Center--Madison

  • Federally Qualified Health Center (FQHC)
  • Madison, NE
National Provider Identifier
1740516764
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
HC050 Issued in NE
Legal business name
MIDTOWN HEALTH CENTER, INC.
Doing business as
Midtown Health Center--Madison
Practice address
222 S Main St
Box 454
Madison, NE 68748-6485
Phone
(402) 454-3304
Fax
(402) 454-2567
NPI assigned
Oct 27, 2009
Last updated
Jul 9, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MIDTOWN HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
Kathy Nordby
Title
Chief Executive Director
Phone
(402) 370-1060

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X HC050 NE
Community Health Clinic/Center 261QC1500X HC050 NE
Federally Qualified Health Center (FQHC) 261QF0400X HC050 NE Primary

Addresses

Primary practice location

222 S Main St
Box 454
Madison, NE 68748-6485

Mailing address

302 W Phillip Ave
Norfolk, NE 68701-5248
Phone (402) 371-8000

Other identifiers 2

IdentifierTypeStateIssuer
10025716900OtherNEMEDICAID FQHC
10025716400MedicaidNE

Other names 1

  • Midtown Health Center--Madison Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040519001227 NE Part B Supplier - Clinic/Group Practice 9133110182 Receives reassigned benefits from 17 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norfolk, NE; Madison, NE
O20100115000612 NE Part A Provider - Federally Qualified Health Center (FQHC) 9133110182 Practice locations: Madison, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740516764. Details of each certification follow.

Federally qualified health center certification: CCN 281813

Legal name
MIDTOWN HEALTH CENTER INC
Doing business as
MIDTOWN HEALTH CENTER - MADISON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2010
Last certification
Jan 15, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 9, 2009 in NE
Enrollment address
222 S Main St
Madison, NE 68748-6485

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Midtown Health Center Inc

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Kathy Nordby Individual Contracted Managing EmployeeExecutive Director Oct 4, 2011 100%
Corporate OfficerExecutive Director Oct 4, 2011 100%
Corporate DirectorExecutive Director Oct 4, 2011 100%
W-2 Managing EmployeeExecutive Director Oct 4, 2011 100%
Operational/Managerial ControlExecutive Director Oct 4, 2011 100%
Midtown Health Center Inc Organization, Madison, NE Operational/Managerial Control Apr 6, 2009
Melodee Drenkow Individual Corporate Director Jul 1, 2017
W-2 Managing Employee Jul 1, 2017
Operational/Managerial Control Jul 1, 2017

Owners & managing parties with NPI records 16

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

View all 16

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Midtown Health Center IncNorfolk, NE, CCN 281812 Federally qualified health center Operational/Managerial Control Aug 1, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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.

NPI Registry JSON

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1740516764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W PHILLIP AVE",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687015248",
            "telephone_number": "402-371-8000",
            "fax_number": "402-371-0971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S MAIN ST",
            "address_2": "BOX 454",
            "city": "MADISON",
            "state": "NE",
            "postal_code": "687486485",
            "telephone_number": "402-454-3304",
            "fax_number": "402-454-2567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWN HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDTOWN HEALTH CENTER, INC.",
        "enumeration_date": "2009-10-27",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "NORDBY",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "402-370-1060"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "HC050",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NE",
            "license": "HC050",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": "HC050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FQHC",
            "identifier": "10025716900",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025716400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midtown Health Center--Madison",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, NE

Sources for this page

Verify at the official NPI Registry.