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Children'S Hospital & Medical Center

Organization Active NPI Multi-Specialty Clinic/Center · Omaha, NE

NPI 1962866418 · NPPES record last updated Oct 2, 2023

Key facts

NPI
1962866418
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
CHILDREN'S HOSPITAL & MEDICAL CENTER
Practice address
110 N 175TH St Ste 1600
Omaha, NE 68118-3581
Phone
(402) 955-5437
NPI assigned
Apr 11, 2016
Organization subpart
No

Authorized official

Name
Chanda C Chacon
Title
President & Ceo
Phone
(402) 955-4106

Owners & managing parties with NPI records 2

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

Other NPIs on the same Medicare enrollment 1

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

Corporate family (same tax ID) 22

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

Practitioners 3

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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospital

Listed as
Children'S Nebraska CCN 283301
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2202217Children'S Nebraska Outpatient Surgery Center
110 North 175TH Street Suite 1600, Omaha, NE 68118		ComplianceOct 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NE

Hospital certification: CCN 283301

Legal name
CHILDRENS HOSPITAL & MEDICAL CENTER
Doing business as
CHILDREN'S NEBRASKA
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Jan 1, 1984
Last certification
Nov 13, 1998
Beds
134
Ownership / control type
Private (not for profit)
Organization structure
Corporation · Non-profit
Incorporated
Nov 30, 1943 in NE
Enrollment address
8200 Dodge St
Omaha, NE 68114-4113
Main/Primary Hospital Location
Hospital subgroups
Children’s, Other

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Chanda C Chacon
Individual 		Corporate Officer
President & Ceo		 Sep 8, 2020
Corporate Director
President & Ceo		 Sep 8, 2020
W-2 Managing Employee
President & Ceo		 Sep 8, 2020
Operational/Managerial Control
President & Ceo		 Sep 8, 2020
Nicole D Birge
Individual 		Corporate Director Jan 1, 2024
Amy D Ryan
Individual 		Corporate Officer Jan 1, 2022
Corporate Director Jan 1, 2017
Stephen P Lindsay
Individual 		Corporate Director Jan 1, 2016
Amy L Hatcher
Individual 		Corporate Officer
Executive VP & Cfo		 Jul 16, 2021
W-2 Managing Employee
Executive VP & Cfo		 Jul 1, 2014
Operational/Managerial Control
Executive VP & Cfo		 Jul 1, 2014
Herbert O Davies
Individual 		Corporate Director Jan 1, 2023
Cindy M Heider
Individual 		Corporate Director Jan 1, 2022
Stacy a Scholtz
Individual 		Corporate Officer Jan 1, 2022
Corporate Director Jan 1, 2018
Farhan Khan
Individual 		Corporate Director Jan 1, 2023
Katherine L English
Individual 		Corporate Officer
Executive VP & Coo		 Jul 16, 2021
W-2 Managing Employee
Executive VP & Coo		 Feb 1, 1993
Operational/Managerial Control
Executive VP & Coo		 Feb 1, 1993
Robert W Dunlay
Individual 		Corporate Director Jan 1, 2013
Samantha J Mosser
Individual 		Corporate Officer Jan 1, 2019
Corporate Director Jan 1, 2016
David a Diamond
Individual 		Corporate Director Jan 1, 2016
Bryan L Wilson
Individual 		Corporate Director Jan 1, 2024
Jonathan Wegner
Individual 		Corporate Director Jan 1, 2021
Margaret M Hershiser
Individual 		Corporate Officer Jan 1, 2017
Corporate Director Jan 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040225000092 NE Part a Provider - Hospital 3173419355 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Omaha, NE

National Provider Directory

Tax ID family
Andrea J Steenson MD (23 organizations share this tax ID)

Locations

14421 DuPont Ct
Omaha, NE 68144
Phone (402) 354-7200

10920 Q St
Omaha, NE 68137
Phone (402) 592-4726

1000 N 90th St
Ste 201
Omaha, NE 68114
Phone (402) 955-6190

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X
Multi-Specialty Clinic/Center 261QM1300X Yes

Addresses

Primary practice location

110 N 175TH St Ste 1600
Omaha, NE 68118-3581

Mailing address

8200 Dodge St
Omaha, NE 68114-4113
Phone (402) 955-5400

Other identifiers

IdentifierTypeStateIssuer
PENDINGMedicaidNE

Other names

  • Children's Hospital & Medical Center Doing business as
  • Children's Nebraska Outpatient Surgery Center Doing business as

Other providers in Omaha, NE

All providers in Omaha, NE · Multi-Specialty Clinic/Center in Nebraska

Sources for this page

Verify at the official NPI Registry.