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Perkins County Hospital District

Organization Active NPI Rural Health Clinic/Center · Grant, NE

NPI 1790792729 · NPPES record last updated Jul 17, 2013

Key facts

NPI
1790792729
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
4142 (NE)
Legal business name
PERKINS COUNTY HOSPITAL DISTRICT
Practice address
912 Central Ave
Grant, NE 69140-3099
Phone
(308) 352-7100
Fax
(308) 352-7103
NPI assigned
Aug 2, 2006
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 5

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

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

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NE

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
Other · Non-profit
Enrollment address
912 Central Ave
Grant, NE 69140-3099
Related CCNs
281356

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 Officer
President/ Ceo		 Jan 22, 2018 100%
W-2 Managing Employee
President/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 Clinic
Ogallala, NE · CCN 288555		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2019
Nov 1, 2019

Medicare enrollment records

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

National Provider Directory

Tax ID family
Grant Medical Clinic (6 organizations share this tax ID)

Specialties & licenses

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

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

  • Grant Medical Clinic Doing business as

Other providers in Grant, NE

All providers in Grant, NE · Rural Health Clinic/Center in Nebraska

Sources for this page

Verify at the official NPI Registry.