Gothenburg Memorial Hospital
Organization Active NPI Critical Access Hospital · Gothenburg, NE
NPI 1922051531 · NPPES record last updated Nov 13, 2025
Key facts
- NPI
- 1922051531
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- GOTHENBURG MEMORIAL HOSPITAL
- Practice address
- 910 20TH St
Gothenburg, NE 69138-1253 - Phone
- (308) 537-3661
- Fax
- (308) 537-3074
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Andrew D Knust
- Title
- Ceo
- Phone
- (308) 537-3661
Owners & managing parties with NPI records 1
-
Brady Dutton Beecham, MD, MPH
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Subparts reporting this organization as parent 4
Related certifications (CCN) 2
Practitioners 25
-
Brady Dutton Beecham, MD, MPH
-
Anna Dalrymple, MD
-
Jordan Amber Haake, APRN
-
Kayla S Knauss, D.O.
-
Garret T Shaw, MD
-
Irfan A Vaziri, MD, MBBS
-
Michelle K Chew, NP
-
Michael Paulus Crisman, PA-C
-
Aaron I Salomon, PAC
-
Lacy J Dye, LIMHP
-
Amanda Dawn Miller, APRN
-
Brady James O'Hare, M.D.
-
Jonathan Blecha, M.D.
-
Sophia Rene Gomez, PA-C
-
John C Evans, CRNA
-
Amy D Graham, CRNA
-
Brooke Sherbeck, CRNA
Affiliated clinicians 68
-
Tyler J Adam, M.D.
-
Loretta L. Baca, M.D.
-
Scot W Bandel, DPM
-
David A Benavides, M.D.
-
Jonathan Blecha, M.D.
-
David Cantral, M.D.
-
Amy Marie Clark, M.D.
-
Michael Paulus Crisman, PA-C
-
Anna Dalrymple, MD
-
Sean Denney, MD
-
Nadia Elias, MD
-
Casey E Fowler, PA-C
-
Valerie Sue Fredericksen, APRN
-
Sophia Rene Gomez, PA-C
-
Gregory I Gordon, M.D.
-
Jordan Amber Haake, APRN
-
Stacy Leigh Haman, APRN
-
John D Hannah, MD
-
Kelley Anne Hasenauer, APRN
Medicare Care Compare: Hospital
- Listed as
- Gothenburg Health
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Hospital certification: CCN 281313
- Legal name
- GOTHENBURG MEMORIAL HOSPITAL
- Doing business as
- GOTHENBURG HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Feb 1, 2000
- Last certification
- Jul 13, 2022
- Beds
- 15
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Enrollment address
- 910 20TH St
Gothenburg, NE 69138-1253
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Ryan O'Hare |
Corporate Officer | Jul 21, 2016 | |
| Corporate Director | Jul 1, 2013 | ||
| Michael Bacon |
Corporate Officer | Jun 1, 2008 | |
| Corporate Director | Jun 1, 2000 | ||
| Claudine N Kennicutt |
Corporate Director | Oct 18, 2023 | |
| Brady D Beecham |
W-2 Managing Employee |
May 22, 2023 | |
| Operational/Managerial Control |
May 22, 2023 | ||
| Andrew D Knust |
Corporate Officer |
Oct 1, 2022 | |
| W-2 Managing Employee |
Oct 1, 2022 | ||
| Operational/Managerial Control |
Oct 1, 2022 | ||
| Monty Bowman |
Corporate Officer | Jun 1, 2008 | |
| Corporate Director | Jun 1, 2000 | ||
| David Jobman |
Corporate Director | Jul 21, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050330001110 | NE | Part B Supplier - Clinic/Group Practice | 6709832983 |
Receives reassigned benefits from 21 practitioners 1 other NPI on this enrollment Practice locations: Gothenburg, NE |
| O20070123000252 | NE | Part a Provider - Critical Access Hospital | 6709832983 |
Receives reassigned benefits from 20 practitioners Practice locations: Gothenburg, NE |
National Provider Directory
Locations
910 20th St
#469
Gothenburg, NE 69138
Phone (308) 537-3661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
910 20TH St
Gothenburg, NE 69138-1253
Mailing address
PO Box 469
Gothenburg, NE 69138-0469
Phone (308) 537-3661
Other names
- Gothenburg Health
Other providers in Gothenburg, NE
- Elizabeth D Gibbens
- Gothenburg Discount Pharmacy Inc.
- Gothenburg Family Practice Rural Health Clinic LLC
- Gothenburg Memorial Hospital
- Gothenburg Memorial Hospital
- Gothenburg Memorial Hospital
- Gothenburg Public Schools
- Gothenburg Public Schools
- Gothenburg Senior Citizen'S Center
- Gothenburg-Cozad Vision Clinic,P.C.
All providers in Gothenburg, NE · Critical Access Hospital in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2025. 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.