NPIMap

Organization Active NPI

Jefferson Community Health Center Inc

Doing business as Jefferson Community Health & Life Fairbury Clinic

  • Rural Health Clinic/Center
  • Fairbury, NE
National Provider Identifier
1922462902
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JEFFERSON COMMUNITY HEALTH CENTER INC
Doing business as
Jefferson Community Health & Life Fairbury Clinic
Practice address
2200 H St
Fairbury, NE 68352-1119
Phone
(402) 729-3361
NPI assigned
Apr 6, 2016
Last updated
Nov 22, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
JEFFERSON COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Authorized official

Name
Burke Kline
Title
Ceo
Phone
(402) 729-3351

Specialties & licenses 3

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

Addresses

Primary practice location

2200 H St
Fairbury, NE 68352-1119

Mailing address

PO Box 277
Fairbury, NE 68352-0277
Phone (402) 729-3351

Other names 1

  • JEFFERSON COMMUNITY HEALTH & LIFE FAIRBURY CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160425000122 NE Part A Provider - Rural Health Clinic 2668574542 Practice locations: Fairbury, NE
O20160506001438 NE Part B Supplier - Clinic/Group Practice 2668574542 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
Practice locations: Fairbury, NE; Lincoln, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922462902. Details of each certification follow.

Rural health clinic certification: CCN 288541

Legal name
JEFFERSON COMMUNITY HEALTH CENTER INC
Doing business as
JEFFERSON COMMUNITY HEALTH & LIFE FAIRBURY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 1996
Last certification
Aug 13, 2020
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2016 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
2200 H St
Fairbury, NE 68352-1119
Related CCNs
281319

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Jefferson Community Inc

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rebecca a Stroklund Individual W-2 Managing EmployeeRHC Medical Director Jun 18, 2021
Operational/Managerial ControlRHC Medical Director Jun 18, 2021
Justin Fulton Individual Corporate Director Jan 16, 2025
Carolyn M Scherbarth Individual Corporate Director Jan 20, 2022
Diane Wellsandt Individual Corporate Director Jan 19, 2023
Kendall Schlake Individual Corporate Director Jan 16, 2025
Sara Stewart Individual Corporate Director Jan 19, 2023
Steven J Snyder Individual Corporate Director Jan 20, 2022
Ashley Norden Individual W-2 Managing EmployeeClinic Administrator May 1, 2020
Operational/Managerial ControlClinic Administrator May 1, 2020
Dallas M Christ Individual Corporate Director Jan 20, 2022
Ross Boeckner Individual Corporate Officer Jan 20, 2022
Corporate Director Jan 1, 2020
Holly Wolff Individual Corporate OfficerCeo Jan 6, 2025
W-2 Managing EmployeeCeo Jan 6, 2025
Chance Klasek Individual Corporate OfficerCfo Apr 21, 2016
W-2 Managing EmployeeCfo Aug 24, 2013
Operational/Managerial ControlCfo Aug 24, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Jefferson Community Health & Life GardensideFairbury, NE, CCN 285282 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 25, 2009
Dec 26, 2024

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1922462902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "FAIRBURY",
            "state": "NE",
            "postal_code": "683520277",
            "telephone_number": "402-729-3351",
            "fax_number": "402-729-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 H ST",
            "city": "FAIRBURY",
            "state": "NE",
            "postal_code": "683521119",
            "telephone_number": "402-729-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2016-04-06",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "BURKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-729-3351"
    },
    "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JEFFERSON COMMUNITY HEALTH & LIFE FAIRBURY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairbury, NE

Sources for this page

Verify at the official NPI Registry.