NPIMap

Organization Active NPI

Memorial Community Hospital Corporation

  • Rural Health Clinic/Center
  • Blair, NE
National Provider Identifier
1922166453
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
79001 Issued in NE
Legal business name
MEMORIAL COMMUNITY HOSPITAL CORPORATION
Practice address
812 N. 22ND St
Blair, NE 68008-1128
Phone
(402) 426-2182
Fax
(402) 426-1191
NPI assigned
Dec 5, 2006
Organization subpart
Yes
Parent organization
MEMORIAL COMMUNITY HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Amy Zimmer
Title
Cne/VP Patient Care Services
Phone
(402) 426-2182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 79001 NE Primary

Addresses

Primary practice location

812 N. 22ND St
Blair, NE 68008-1128

Mailing address

812 N. 22ND St
Blair, NE 68008-1128
Phone (402) 426-2182

Other identifiers 2

IdentifierTypeStateIssuer
01802OtherNEBLUE CROSS BLUE SHIELD GR
10025024000MedicaidNE

Other names 1

  • MCH Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030624000016 NE Part A Provider - Rural Health Clinic 0749190775 Practice locations: Blair, NE

Other NPIs with the same Medicare PAC ID 4

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

Rural health clinic certification: CCN 283462

Legal name
MEMORIAL COMMUNITY HOSPITAL CORPORATION
Doing business as
MCH PHYSICIANS; BLAIR CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 3, 2003
Last certification
Jan 18, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1963 in NE
Enrollment address
812 N 22ND St
Blair, NE 68008-1128
Related CCNs
281359

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

National Provider Directory

National Provider Directory
Tax ID family
Cott Rural Health Clinic5 organizations share this tax ID, including this one
Part of
Cott Rural Health Clinic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Memorial Community Hospital Corporation Organization, Blair, NE Non-profit Operational/Managerial Control Apr 1, 2002 60%
Alegent Creighton Health Organization, Omaha, NE Non-profit Other Apr 1, 2002
Manuela Wolf Individual Contracted Managing EmployeePresident/Ceo Mar 1, 2018
Operational/Managerial ControlPresident/Ceo Mar 1, 2018
Amy Zimmer Individual Corporate OfficerCne/VP of Patient Services Dec 7, 2020
Corporate DirectorCne/VP of Patient Services Dec 7, 2020
W-2 Managing EmployeeCne/VP Patient Care Services Dec 7, 2020
Operational/Managerial ControlCne/VP of Patient Services Dec 7, 2020
Evert Kuiper Individual Other Jan 1, 2022
Alegent Health Immanuel Medical Center Organization, Omaha, NE Non-profit Operational/Managerial Control Apr 1, 2002 40%
Melissa Templar Individual W-2 Managing EmployeeMedical Staff Liaison Aug 26, 2004

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Operational/Managerial Control (60%) Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Operational/Managerial Control (60%) Apr 1, 2002
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Operational/Managerial Control (60%) Apr 1, 2002
Fort Calhoun ClinicFort Calhoun, NE, CCN 288506 Rural health clinic Operational/Managerial Control (60%) Apr 1, 2002

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

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 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0453423MCH Physicians812 North 22ND Street, Blair, NE 68008Provider-performed microscopyDec 22, 2027

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1922166453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 N. 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-2182",
            "fax_number": "402-426-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 N. 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-2182",
            "fax_number": "402-426-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "enumeration_date": "2006-12-05",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "ZIMMER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CNE/VP PATIENT CARE SERVICES",
        "authorized_official_telephone_number": "402-426-2182"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NE",
            "license": "79001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD GR",
            "identifier": "01802",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025024000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCH Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCH Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blair, NE

Sources for this page

Verify at the official NPI Registry.