NPIMap

Organization Active NPI

Pender Community Hospital District

Doing business as PCH Medical Clinic - Pender

  • Rural Health Clinic/Center
  • Pender, NE
National Provider Identifier
1972931657
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PENDER COMMUNITY HOSPITAL DISTRICT
Doing business as
PCH Medical Clinic - Pender
Pender Medical Clinic
Practice address
958 Wellness Way Ste 1
Pender, NE 68047-4518
Phone
(402) 385-3033
NPI assigned
Oct 16, 2013
Last updated
May 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PENDER COMMUNITY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Authorized official

Name
Laura J Gamble
Title
Ceo
Phone
(402) 385-3083

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

958 Wellness Way Ste 1
Pender, NE 68047-4518

Mailing address

PO Box 100
Pender, NE 68047-0100
Phone (402) 385-4012

Other names 2

  • PCH MEDICAL CLINIC - PENDER Doing business as
  • Pender Medical 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
O20090206000139 NE Part B Supplier - Clinic/Group Practice 3971412842 Receives reassigned benefits from 44 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pender, NE
O20140204000938 NE Part A Provider - Rural Health Clinic 3971412842 Practice locations: Pender, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972931657. Details of each certification follow.

Rural health clinic certification: CCN 288526

Legal name
PENDER COMMUNITY HOSPITAL DISTRICT
Doing business as
PENDER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 1, 2013
Last certification
Feb 14, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
958 Wellness Way
Ste 1
Pender, NE 68047-4518
Related CCNs
281349

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0453581PCH Medical Clinic - Pender958 Wellness Way, Suite 1, Pender, NE 68047ComplianceAug 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pender Community District8 organizations share this tax ID, including this one
Part of
Pender Community District

Other organizations with this tax ID 7

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

Locations

100 Valley View Dr
Ste 1
Pender, NE 68047
Phone (402) 385-3033

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Michael C Minert Individual Corporate Officer Jun 30, 2014
Corporate Director May 8, 2012
Shane Schuster Individual W-2 Managing EmployeeChief Operating Officer Sep 1, 2021
Operational/Managerial ControlChief Operating Officer Sep 1, 2021
Matthew J Timm Individual W-2 Managing EmployeeMD; Feb 13, 2024
Operational/Managerial ControlMedical Director Feb 13, 2024
Lori a Minert Individual W-2 Managing EmployeeAd;Clinic Manager Sep 14, 2014
Operational/Managerial ControlClinic Manager Sep 14, 2014
Lorraine M Lander Individual Corporate Officer Jun 25, 2018
Corporate Director Jun 30, 2014
Diane J Moeller Individual Corporate Director Jun 27, 2022
Sheri Fillipi Individual Corporate Officer Jun 27, 2022
Corporate Director Oct 14, 2020
Marlon Hennig Individual Corporate Director Dec 11, 2023
Laura J Gamble Individual Corporate OfficerCeo Oct 17, 2022
W-2 Managing EmployeeCeo Oct 17, 2022
Operational/Managerial ControlCeo Oct 17, 2022
Kimberly J Hixson Individual W-2 Managing EmployeeCfo Mar 26, 2024
Operational/Managerial ControlCfo Mar 26, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1972931657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680470100",
            "telephone_number": "402-385-4012",
            "fax_number": "402-385-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 WELLNESS WAY STE 1",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680474518",
            "telephone_number": "402-385-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "enumeration_date": "2013-10-16",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-385-3083"
    },
    "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": "PCH MEDICAL CLINIC - PENDER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pender Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pender Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pender, NE

Sources for this page

Verify at the official NPI Registry.