Community Medical Center, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COMMUNITY MEDICAL CENTER, INC

Doing business as

Humboldt Family Medicine

Practice address

1120 Grand Ave
Humboldt, NE 68376-6019

Phone

(402) 862-3280

Fax

(402) 862-3284

NPI assigned

May 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan C Larsen

Title

Ceo

Phone

(402) 245-2428

Specialties & licenses 1

Addresses

Other names 1

• Humboldt Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NE2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851348544. Details of each certification follow.

• CCN 283493 Rural health clinic · Active · Details

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

CorporationProprietary

Incorporated

Jul 20, 1955 in NE

Enrollment address

1120 Grand Ave
Humboldt, NE 68376-6019

Related CCNs

281352

Related certifications (CCN) 1

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

• Community Medical Center, Inc.

  • Critical Access Hospital
  • Falls City, NE
  • NPI 1881643484

  Parent provider

  Provider of Services

Other NPIs with the same Medicare PAC ID 3

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

• Community Medical Center, Inc

  dba Family Medicine

  • Family Medicine Physician
  • Falls City, NE
  • NPI 1194767285

  6608776943

  Same PAC ID
• Community Medical Center, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Falls City, NE
  • NPI 1669429635

  6608776943

  Same PAC ID
• Community Medical Center, Inc.

  • Critical Access Hospital
  • Falls City, NE
  • NPI 1881643484

  6608776943

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

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

• Community Medical Center, Inc

  dba Family Medicine

  • Family Medicine Physician
  • Falls City, NE
  • NPI 1194767285

  O20040112000200

  Same enrollment
• Community Medical Center, Inc.

  • Critical Access Hospital
  • Falls City, NE
  • NPI 1881643484

  O20040112000200

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

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

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851348544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "FALLS CITY",
            "state": "NE",
            "postal_code": "683550399",
            "telephone_number": "402-245-4475",
            "fax_number": "402-245-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 GRAND AVE",
            "city": "HUMBOLDT",
            "state": "NE",
            "postal_code": "683766019",
            "telephone_number": "402-862-3280",
            "fax_number": "402-862-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-245-2428"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humboldt Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jackie Lynne Benson, MOT, OTR/L, CLT
• Emma Blakesly-Cash
• Vicki Bursovsky
• City of Humboldt
• Colonial Acres of Humboldt (Colonial Acres Nursing Home)
• Ashley Eickhoff, DPT
• Stacy Fankhauser
• Teresa Gartner
• Jacob Heil
• Humboldt Table Rock Steinauer

• Family Medicine Physician in Humboldt, NE
• Providers in Humboldt, NE by specialty
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.