NPIMap

Organization Active NPI

Providence Medical Center

  • Critical Access Hospital
  • Wayne, NE
National Provider Identifier
1801867494
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
PROVIDENCE MEDICAL CENTER
Practice address
1200 Providence Road
Wayne, NE 68787-1212
Phone
(402) 375-7960
Fax
(402) 375-7989
NPI assigned
Jan 31, 2006
Last updated
Mar 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Ms. Nicole Haglund
Title
Ceo
Phone
(402) 375-7954

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 800001 NE
Critical Access Hospital 282NC0060X NE Primary

Addresses

Primary practice location

1200 Providence Road
Wayne, NE 68787-1212

Mailing address

1200 Providence Road
Wayne, NE 68787-1212
Phone (402) 375-7960

Other practice location 1

308 Ash St
Wakefield, NE 68784-5023
Phone (402) 287-1005

Other practice location 2

699 Cedar Ave
Laurel, NE 68745-1703
Phone (402) 256-9551

Other identifiers 1

IdentifierTypeStateIssuer
800001MedicaidNE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041124000342 NE Part B Supplier - Clinic/Group Practice 4587629928 Receives reassigned benefits from 56 practitioners
1 other NPI on this enrollment
Practice locations: Wayne, NE
O20071129000010 NE Part A Provider - Critical Access Hospital 4587629928 Receives reassigned benefits from 25 practitioners
Practice locations: Laurel, NE; Wakefield, NE; Wayne, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801867494. Details of each certification follow.

Hospital certification: CCN 281345

Legal name
PROVIDENCE MEDICAL CENTER
Doing business as
PROVIDENCE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2001
Last certification
Aug 8, 2024
Beds
21
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1200 Providence Rd
Wayne, NE 68787-1212
Main/Primary Hospital Location

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).

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Medical CenterCCN 281345 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

308 Ash St
Wakefield, NE 68784
Phone (402) 287-1005

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Matthew Ley Individual Corporate OfficerBoard Member Jan 1, 2016
Providence Medical Center Organization, Wayne, NE Non-profit 5% Or Greater Direct Ownership Interest Mar 2, 2010 100%
Nicole Haglund Individual Corporate DirectorCeo Mar 1, 2025
W-2 Managing EmployeeCeo Mar 1, 2025
Brittany Peters Individual Corporate Director Jan 1, 2016

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 58

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 58

Affiliated clinicians 74

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1801867494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 PROVIDENCE ROAD",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871212",
            "telephone_number": "402-375-7960",
            "fax_number": "402-375-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 PROVIDENCE ROAD",
            "city": "WAYNE",
            "state": "NE",
            "postal_code": "687871212",
            "telephone_number": "402-375-7960",
            "fax_number": "402-375-7989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 Ash St",
            "address_purpose": "LOCATION",
            "city": "Wakefield",
            "state": "NE",
            "postal_code": "687845023",
            "country_code": "US",
            "telephone_number": "402-287-1005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "699 Cedar Ave",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "NE",
            "postal_code": "687451703",
            "country_code": "US",
            "telephone_number": "402-256-9551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "HAGLUND",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-375-7954",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NE",
            "license": "800001",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800001",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NE

Sources for this page

Verify at the official NPI Registry.