NPIMap

Organization Active NPI

Perkins County Hospital District

Doing business as Grant Medical Clinic

  • Rural Health Clinic/Center
  • Grant, NE
National Provider Identifier
1790792729
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4142 Issued in NE
Legal business name
PERKINS COUNTY HOSPITAL DISTRICT
Doing business as
Grant Medical Clinic
Practice address
912 Central Ave
Grant, NE 69140-3099
Phone
(308) 352-7100
Fax
(308) 352-7103
NPI assigned
Aug 2, 2006
Last updated
Jul 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Authorized official

Name
James Lebrun
Title
Ceo
Phone
(308) 352-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4142 NE Primary

Addresses

Primary practice location

912 Central Ave
Grant, NE 69140-3099

Mailing address

912 Central Ave
Grant, NE 69140-3099
Phone (308) 352-7100

Other names 1

  • Grant Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030410000020 NE Part A Provider - Rural Health Clinic 0840109823 Practice locations: Grant, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790792729. Details of each certification follow.

Rural health clinic certification: CCN 283989

Legal name
PERKINS COUNTY HOSPITAL DISTRICT
Doing business as
GRANT MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 31, 1992
Last certification
Jul 25, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
912 Central Ave
Grant, NE 69140-3099
Related CCNs
281356

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Grant Medical Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Neil Hilton Individual Corporate OfficerPresident/ Ceo Jan 22, 2018 100%
W-2 Managing EmployeePresident/Ceo Jan 22, 2018 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Perkins County Family ClinicOgallala, NE, CCN 288555 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2019
Nov 1, 2019

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1790792729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 CENTRAL AVE",
            "city": "GRANT",
            "state": "NE",
            "postal_code": "691403099",
            "telephone_number": "308-352-7100",
            "fax_number": "308-352-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 CENTRAL AVE",
            "city": "GRANT",
            "state": "NE",
            "postal_code": "691403099",
            "telephone_number": "308-352-7100",
            "fax_number": "308-352-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERKINS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "LEBRUN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-352-7200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NE",
            "license": "4142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grant Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grant, NE

Sources for this page

Verify at the official NPI Registry.