NPIMap

Organization Active NPI

Phelps Memorial Health Center

Doing business as Phelps Medical Group

  • Rural Health Clinic/Center
  • Holdrege, NE
National Provider Identifier
1891189809
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHELPS MEMORIAL HEALTH CENTER
Doing business as
Phelps Medical Group
Practice address
1315 Tibbals St
Holdrege, NE 68949-1257
Phone
(308) 995-6111
NPI assigned
Mar 27, 2015
Last updated
Jun 6, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PHELPS MEMORIAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

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

Authorized official

Name
Mr. Mark D Harrel
Title
Ceo
Phone
(308) 995-2211

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1315 Tibbals St
Holdrege, NE 68949-1257

Mailing address

1215 Tibbals St
Holdrege, NE 68949-1255
Phone (308) 995-2211

Other names 1

  • Phelps Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160802001826 NE Part A Provider - Rural Health Clinic 9931011947 Practice locations: Holdrege, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891189809. Details of each certification follow.

Rural health clinic certification: CCN 288543

Legal name
PHELPS MEMORIAL HEALTH CENTER
Doing business as
PHELPS MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 7, 2016
Last certification
Dec 7, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 12, 1963 in NE
Enrollment address
1315 Tibbals St
Holdrege, NE 68949-1257
Related CCNs
281362

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Part of
Phelps Memorial HLTH Ctr

Locations

1723 Burlington St
Holdrege, NE 68949
Phone (308) 995-2865

211 W 14th Ave
Holdrege, NE 68949
Phone (308) 995-2172

414 East Ave
Bsmt
Holdrege, NE 68949
Phone 30899521752

516 W 14th Ave
Ste 200
Holdrege, NE 68949
Phone (308) 529-3453

516 W 14th Ave
Ste 300
Holdrege, NE 68949
Phone (308) 995-2211

516 W 14th Ave
Ste 400
Holdrege, NE 68949
Phone (308) 995-2211

201 S 68th Street Pl
Lincoln, NE 68510
Phone (402) 420-7000

11135 Mill Valley Rd
Omaha, NE 68154

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Benjamin Z Egger Individual Contracted Managing EmployeeMD; Apr 16, 2021
Operational/Managerial ControlMedical Director Apr 16, 2021
Loren D Schroder Individual Corporate OfficerCfo Aug 6, 2018
W-2 Managing EmployeeCfo Aug 1, 2018
Operational/Managerial ControlCfo Dec 1, 2001
Michael L Pelster Individual Corporate Officer May 6, 2019
Corporate Director Apr 18, 2017
Mark R Kraus Individual Corporate Director Jun 2, 2020
Tiffany Wiser Individual W-2 Managing EmployeeAd;Clinic Manager Oct 24, 2022
Operational/Managerial ControlClinic Manager Oct 24, 2022
Donald D Kraus Individual Corporate Director Apr 18, 2023
Kyle L Anderson Individual Corporate Officer Oct 2, 2023
Corporate Director Apr 12, 2022
Lance a Thorell Individual Corporate Director Nov 6, 2023
Howard S Kness Individual Corporate Officer Apr 21, 2022
Corporate Director Apr 16, 2020
Douglas M Hohman Individual Corporate Director Apr 18, 2023
Linda Jo Heiden Individual Corporate Officer Oct 2, 2023
Corporate Director Apr 12, 2022
Heather K McQuillan Individual Corporate Director Apr 18, 2023
Stephanie Dannehl Individual Corporate Director Apr 13, 2021
William M Sandy Individual Corporate Director Apr 16, 2024
Jeffrey R Berney Individual Corporate Director Jan 1, 2023
Mark D Harrel Individual Corporate OfficerCeo Aug 6, 2018
W-2 Managing EmployeeCeo Aug 1, 2018
Operational/Managerial ControlCeo Jul 9, 2007

Owners & managing parties with NPI records 4

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

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 100

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 100

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559779200000",
    "number": "1891189809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 TIBBALS ST",
            "city": "HOLDREGE",
            "state": "NE",
            "postal_code": "689491255",
            "telephone_number": "308-995-2211",
            "fax_number": "308-995-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 TIBBALS ST",
            "city": "HOLDREGE",
            "state": "NE",
            "postal_code": "689491257",
            "telephone_number": "308-995-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHELPS MEMORIAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHELPS MEMORIAL HEALTH CENTER",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-06-06",
        "status": "A",
        "authorized_official_last_name": "HARREL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-995-2211",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phelps Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phelps Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holdrege, NE

Sources for this page

Verify at the official NPI Registry.