Community Medical Center, Inc
Organization Active NPI Family Medicine Physician · Humboldt, NE
NPI 1851348544 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1851348544
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- COMMUNITY MEDICAL CENTER, INC
- Practice address
- 1120 Grand Ave
Humboldt, NE 68376-6019 - Phone
- (402) 862-3280
- Fax
- (402) 862-3284
- NPI assigned
- May 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Ryan C Larsen
- Title
- Ceo
- Phone
- (402) 245-2428
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Practitioners 12
-
Mary C Jones, P.A.
-
Sandra Sue Catlin, APRN
-
Alyssa Finck, D.O.
-
Gayle Lynette Keller, APRN
-
Carrie Ann Ramsey, PA-C
-
Amy Reafleng, APRN
-
Adam R Streit, D.O.
-
Justin Ryan Westengaard, M.D.
-
Juli Habegger, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D1041323 | Humboldt Family Medicine | Compliance | Oct 12, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Rural health clinic certification: CCN 283493
- Legal name
- COMMUNITY MEDICAL CENTER INC
- Doing business as
- HUMBOLDT FAMILY MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 24, 2005
- Last certification
- Jun 1, 2026
- Ownership / control type
- 2B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jul 20, 1955 in NE
- Enrollment address
- 1120 Grand Ave
Humboldt, NE 68376-6019 - Related CCNs
- 281352
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Ryan Larsen |
Corporate Officer |
Sep 6, 2005 | |
| W-2 Managing Employee |
Sep 6, 2005 | ||
| Nicole Mason |
Corporate Director |
Aug 1, 2021 | |
| Operational/Managerial Control | Aug 1, 2021 | ||
| Bonnie Kanel |
Operational/Managerial Control |
Aug 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040112000200 | NE | Part B Supplier - Clinic/Group Practice | 6608776943 |
Receives reassigned benefits from 22 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Falls City, NE; Humboldt, NE |
| O20050308000278 | NE | Part a Provider - Rural Health Clinic | 6608776943 | Practice locations: Humboldt, NE |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1120 Grand Ave
Humboldt, NE 68376-6019
Mailing address
PO Box 399
Falls City, NE 68355-0399
Phone (402) 245-4475
Other names
- Humboldt Family Medicine
Other providers in Humboldt, NE
- Jackie Lynne Benson
- Emma Blakesly-Cash
- Vicki Bursovsky
- City of Humboldt
- Colonial Acres of Humboldt
- Ashley Eickhoff
- Stacy Fankhauser
- Teresa Gartner
- Jacob Heil
- Humboldt Table Rock Steinauer
All providers in Humboldt, NE · Family Medicine Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.