NPIMap

Organization Active NPI

Merrick Medical Center

Doing business as Merrick Medical Center Professional Services

  • Emergency Medicine Physician
  • Central City, NE
National Provider Identifier
1790216174
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MERRICK MEDICAL CENTER
Doing business as
Merrick Medical Center Professional Services
Practice address
2802 28TH St
Central City, NE 68826-2707
Phone
(308) 946-3015
Fax
(308) 946-5914
NPI assigned
Mar 27, 2017
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MERRICK MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Jodi S Mohr
Title
Ceo
Phone
(402) 946-3015

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary
Family Medicine Physician 207Q00000X
Sports Medicine (Family Medicine) Physician 207QS0010X
Physician Assistant 363A00000X
Certified Registered Nurse Anesthetist 367500000X

Addresses

Primary practice location

2802 28TH St
Central City, NE 68826-2707

Mailing address

PO Box 860874
Minneapolis, MN 55486-0874
Phone (308) 946-3015

Other names 1

  • MERRICK MEDICAL CENTER PROFESSIONAL SERVICES Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@hisp.bryanhealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170512000681 NE Part B Supplier - Clinic/Group Practice 9537445812 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
Practice locations: Central City, NE; Lincoln, NE

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 2

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

National Provider Directory

National Provider Directory
Part of
Merrick Medical Center

Ownership & related parties

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 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1790216174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860874",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860874",
            "telephone_number": "308-946-3015",
            "fax_number": "308-946-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 28TH ST",
            "city": "CENTRAL CITY",
            "state": "NE",
            "postal_code": "688262707",
            "telephone_number": "308-946-3015",
            "fax_number": "308-946-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERRICK MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERRICK MEDICAL CENTER",
        "enumeration_date": "2017-03-27",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "MOHR",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-946-3015"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@hisp.bryanhealth.org",
            "affiliation": "N",
            "address_1": "1600 S 48th St",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685061299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MERRICK MEDICAL CENTER PROFESSIONAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Central City, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.