NPIMap

Organization Active NPI

Memorial Community Hospital Corporation

Doing business as Cottonwood Rural Health Clinic

  • Rural Health Clinic/Center
  • Tekamah, NE
National Provider Identifier
1952487589
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
Doing business as
Cottonwood Rural Health Clinic
Practice address
3519 Highway 32
Tekamah, NE 68061-5095
Phone
(402) 374-1585
Fax
(402) 374-1612
NPI assigned
Oct 27, 2006
Last updated
Oct 4, 2023By the provider in NPPES
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

3519 Highway 32
Tekamah, NE 68061-5095

Mailing address

3519 Highway 32
Tekamah, NE 68061-5095
Phone (402) 374-1585

Other identifiers 1

IdentifierTypeStateIssuer
098384OtherNERHC MEDICARE

Other names 1

  • Cottonwood Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061130000116 NE Part A Provider - Rural Health Clinic 0749190775 Practice locations: Tekamah, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952487589. Details of each certification follow.

Rural health clinic certification: CCN 283404

Legal name
MEMORIAL COMMUNITY HOSPITAL CORPORATION
Doing business as
COTTONWOOD RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 20, 1994
Last certification
Apr 20, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
3519 Highway 32
Tekamah, NE 68061-5095
Related CCNs
281359

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).

National Provider Directory

National Provider Directory
Tax ID family
Memorial Comm Hospital5 organizations share this tax ID, including this one
Part of
Memorial Comm Hospital

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 EmployeeCeo/President Mar 1, 2018
Corporate OfficerCeo/President 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 Oct 31, 2006 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
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 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 & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1952487589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 HIGHWAY 32",
            "city": "TEKAMAH",
            "state": "NE",
            "postal_code": "680615095",
            "telephone_number": "402-374-1585",
            "fax_number": "402-374-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3519 HIGHWAY 32",
            "city": "TEKAMAH",
            "state": "NE",
            "postal_code": "680615095",
            "telephone_number": "402-374-1585",
            "fax_number": "402-374-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL COMMUNITY HOSPITAL CORPORATION",
        "enumeration_date": "2006-10-27",
        "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": "RHC MEDICARE",
            "identifier": "098384",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottonwood Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cottonwood Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tekamah, NE

Sources for this page

Verify at the official NPI Registry.