NPIMap

Organization Active NPI

Callaway Hospital District

Doing business as Callaway Medical Clinic

  • Rural Health Clinic/Center
  • Callaway, NE
National Provider Identifier
1962519074
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CALLAWAY HOSPITAL DISTRICT
Doing business as
Callaway Medical Clinic
Practice address
213 E Kimball St
Callaway, NE 68825-2596
Phone
(308) 836-2294
Fax
(308) 836-2451
NPI assigned
Aug 24, 2006
Last updated
Jan 16, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
CALLAWAY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Authorized official

Name
Mr. Brett D. Eggleston
Title
Ceo
Phone
(308) 836-2228

Specialties & licenses 1

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

Addresses

Primary practice location

213 E Kimball St
Callaway, NE 68825-2596

Mailing address

PO Box 100
Callaway, NE 68825-0100
Phone (308) 836-2228

Other identifiers 1

IdentifierTypeStateIssuer
10025127100MedicaidNE

Other names 1

  • Callaway Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040709000071 NE Part A Provider - Rural Health Clinic 0143208983 Practice locations: Callaway, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962519074. Details of each certification follow.

Rural health clinic certification: CCN 283476

Legal name
CALLAWAY HOSPITAL DISTRICT
Doing business as
CALLAWAY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 29, 2004
Last certification
Feb 4, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
213 E Kimball St
Callaway, NE 68825-2596
Related CCNs
281335

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
Callaway District Hospital5 organizations share this tax ID, including this one
Part of
Callaway District 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 9

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

NameRoleSinceShare
Amy M Lewandowski Individual W-2 Managing EmployeeRHC Clinic Nursing Manager Nov 1, 2022
Operational/Managerial ControlRHC Clinic Nursing Manager Nov 1, 2022
Cassie D Penn Individual W-2 Managing EmployeeCoo Dec 4, 2023
Operational/Managerial ControlCoo Dec 4, 2023
Gregory Johnson Individual Corporate Officer Jun 18, 2013
Corporate Director Jun 1, 2000
Mary Ross Individual Corporate Officer Jun 1, 1998
Corporate Director Jun 1, 1998
Kenneth L Loper Individual W-2 Managing EmployeeMedical Director Nov 19, 2014
Operational/Managerial ControlMedical Director Nov 19, 2014
Zachary Meyer Individual Corporate Officer Jul 16, 2019
Corporate Director Jul 16, 2019
James Jenkins Individual Corporate Director Apr 16, 2019
Brett D Eggleston Individual Corporate OfficerCeo Jun 20, 2017
W-2 Managing EmployeeCeo Sep 1, 2016
Operational/Managerial ControlCeo Sep 1, 2016
Mark Kimball Individual Corporate Director Jun 1, 1998

Owners & managing parties with NPI records 2

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1962519074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "CALLAWAY",
            "state": "NE",
            "postal_code": "688250100",
            "telephone_number": "308-836-2228",
            "fax_number": "308-836-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 E KIMBALL ST",
            "city": "CALLAWAY",
            "state": "NE",
            "postal_code": "688252596",
            "telephone_number": "308-836-2294",
            "fax_number": "308-836-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALLAWAY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALLAWAY HOSPITAL DISTRICT",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "EGGLESTON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-836-2228",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025127100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Callaway Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Callaway Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Callaway, NE

Sources for this page

Verify at the official NPI Registry.