NPIMap

Organization Active NPI

Crete Area Medical Center

  • Rural Health Clinic/Center
  • Crete, NE
National Provider Identifier
1841240744
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRETE AREA MEDICAL CENTER
Practice address
2910 Betten Dr
Crete, NE 68333-3084
Phone
(402) 826-2102
Fax
(402) 826-7950
NPI assigned
May 11, 2006
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CRETE AREA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Julie Lacy
Title
President & Ceo
Phone
(402) 826-2102

Specialties & licenses 1

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

Addresses

Primary practice location

2910 Betten Dr
Crete, NE 68333-3084

Mailing address

PO Box 860876
Minneapolis, MN 55486-0873
Phone (402) 826-2102

Other identifiers 1

IdentifierTypeStateIssuer
10025113200MedicaidNE

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
O20040709000130 NE Part A Provider - Rural Health Clinic 4385556216 Practice locations: Crete, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841240744. Details of each certification follow.

Rural health clinic certification: CCN 283468

Legal name
CRETE AREA MEDICAL CENTER
Doing business as
CRETE AREA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2004
Last certification
Nov 14, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 2001 in NE
Enrollment address
2910 Betten Dr
Crete, NE 68333-3084
Related CCNs
281354

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Crete Area Medical Cent6 organizations share this tax ID, including this one
Part of
Crete Area Medical Cent

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 11

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

NameRoleSinceShare
Michael J Kozisek Individual Corporate Officer Jan 1, 2024
Corporate Director Jan 1, 2023
Russell J Ebke Individual W-2 Managing EmployeeMD; Jun 1, 2015
Operational/Managerial ControlMedical Director Jun 1, 2015
Maria Isquierdo Individual Corporate Director Jan 1, 2022
Jason K Hesser Individual Corporate Director Jan 1, 2023
Eric S Post Individual Corporate Officer Jan 1, 2024
Corporate Director Jan 1, 2023
Patrick D Ganyo Individual Corporate Director Jul 1, 2024
Bryan Health Organization, Lincoln, NE Corporation, Non-profit, Chain home office Operational/Managerial Control Feb 1, 2002
Julie Lacy Individual Corporate OfficerPresident & Ceo Jul 1, 2024
Corporate DirectorPresident & Ceo Jul 1, 2024
W-2 Managing EmployeePresident & Ceo Jul 1, 2024
Operational/Managerial ControlPresident & Ceo Jul 1, 2024
David K Newmyer Individual Corporate Director Jan 1, 2024
Guadalupe C Avelar Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2020
Stephanie R Hollman Individual W-2 Managing EmployeeClinic Operations Director Apr 12, 2010
Operational/Managerial ControlClinic Operations Director Apr 12, 2010

Owners & managing parties with NPI records 2

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

Facilities with the same owner 17

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

View all 17

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 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1841240744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860876",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860873",
            "telephone_number": "402-826-2102",
            "fax_number": "402-826-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 BETTEN DR",
            "city": "CRETE",
            "state": "NE",
            "postal_code": "683333084",
            "telephone_number": "402-826-2102",
            "fax_number": "402-826-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRETE AREA MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRETE AREA MEDICAL CENTER",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "402-826-2102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025113200",
            "state": "NE"
        }
    ],
    "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": []
}

Other providers in Crete, NE

Sources for this page

Verify at the official NPI Registry.