Jefferson Community Health Center Inc
Organization Active NPI Rural Health Clinic/Center · Fairbury, NE
NPI 1922462902 · NPPES record last updated Nov 22, 2022
Key facts
- NPI
- 1922462902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- JEFFERSON COMMUNITY HEALTH CENTER INC
- Practice address
- 2200 H St
Fairbury, NE 68352-1119 - Phone
- (402) 729-3361
- NPI assigned
- Apr 6, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- JEFFERSON COMMUNITY HEALTH CENTER INC
Authorized official
- Name
- Burke Kline
- Title
- Ceo
- Phone
- (402) 729-3351
Owners & managing parties with NPI records 1
-
Rebecca Anne Stroklund, D.O.
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Practitioners 35
-
Kirisha N Afuh, APRN
-
Richard A Blum, PA-C
-
Matthew Gatlin, PA-C
-
Jacqueline Hanson, D.O.
-
Abby N Hanzlicek, M.D.
-
Larissa L Hoffman, APRN
-
Megan M Knutson, APRN
-
Jeffrey T Marple, M.D.
-
Jaime Jo Pieper, DO
-
Rebecca Anne Stroklund, D.O.
-
Todd W. Stuckey, M.D.
-
Nicole J Topliff, ARNP
-
Brett Wergin, MD
-
James Bruce White II, FNP
-
Keegan J Williams, APRN
-
Kensly N Williams, PA-C
-
Jonathan Wood, MD
-
Lexia Rae Zenger, MD
-
Megan L Corbin, APRN
-
Syed Akbar, DO
-
Eric J. Avery, M.D.
-
Quinton S Kelly, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
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
- Corporation · Non-profit
- Enrollment address
- 2200 H St
Fairbury, NE 68352-1119 - Related CCNs
- 281319
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Rebecca a Stroklund |
W-2 Managing Employee |
Jun 18, 2021 | |
| Operational/Managerial Control |
Jun 18, 2021 | ||
| Justin Fulton |
Corporate Director | Jan 16, 2025 | |
| Carolyn M Scherbarth |
Corporate Director | Jan 20, 2022 | |
| Diane Wellsandt |
Corporate Director | Jan 19, 2023 | |
| Kendall Schlake |
Corporate Director | Jan 16, 2025 | |
| Sara Stewart |
Corporate Director | Jan 19, 2023 | |
| Steven J Snyder |
Corporate Director | Jan 20, 2022 | |
| Ashley Norden |
W-2 Managing Employee |
May 1, 2020 | |
| Operational/Managerial Control |
May 1, 2020 | ||
| Dallas M Christ |
Corporate Director | Jan 20, 2022 | |
| Ross Boeckner |
Corporate Officer | Jan 20, 2022 | |
| Corporate Director | Jan 1, 2020 | ||
| Holly Wolff |
Corporate Officer |
Jan 6, 2025 | |
| W-2 Managing Employee |
Jan 6, 2025 | ||
| Chance Klasek |
Corporate Officer |
Apr 21, 2016 | |
| W-2 Managing Employee |
Aug 24, 2013 | ||
| Operational/Managerial Control |
Aug 24, 2013 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Jefferson Community Health & Life Gardenside |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Sep 25, 2009 Dec 26, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Jefferson Co Mem Hosp Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Physician Assistant |
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
- JEFFERSON COMMUNITY HEALTH & LIFE FAIRBURY CLINIC
Other providers in Fairbury, NE
- Rebecca Herrington
- Morgan Hill
- Larissa L Hoffman
- Tracy Holsing
- Elizabeth Hyson
- Jefferson Community Health Center, Inc
- Jefferson Community Health Center, Inc.
- Jefferson Community Health Center, Inc.
- Jefferson Community Health Center, Inc.
- Jefferson Community Health Center, Inc.
All providers in Fairbury, NE · Rural Health Clinic/Center 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 22, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.