NPIMap

Jefferson Community Health Center, Inc.

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Fairbury, NE

NPI 1992808372 · NPPES record last updated Jun 10, 2014

Key facts

NPI
1992808372
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
440001 (NE)
Legal business name
JEFFERSON COMMUNITY HEALTH CENTER, INC.
Practice address
2200 H St
Box 277
Fairbury, NE 68352-1119
Phone
(402) 729-3351
Fax
(402) 729-2102
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

Name
Chad E Jurgens
Title
Cfo
Phone
(402) 729-3351

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 5

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

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

Practitioners 25

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

Affiliated clinicians 2

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NE

Hospital certification: CCN 28Z319

Legal name
JEFFERSON COMMUNITY HEALTH CENTER INC
Doing business as
JEFFERSON COMMUNITY HEALTH & LIFE
Organization structure
Corporation · Non-profit
Enrollment address
2200 H St
Box 277
Fairbury, NE 68352-0277
Other Hospital Practice Location

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
Justin Fulton
Individual 		Corporate Director Jan 16, 2025
Carolyn M Scherbarth
Individual 		Corporate Director Jan 20, 2022
Diane Wellsandt
Individual 		Corporate Director Jan 19, 2023
Kendall Schlake
Individual 		Corporate Director Jan 16, 2025
Sara Stewart
Individual 		Corporate Director Jan 19, 2023
Steven J Snyder
Individual 		Corporate Director Jan 20, 2022
Dallas M Christ
Individual 		Corporate Director Jan 20, 2022
Ross Boeckner
Individual 		Corporate Director
Vice Chairman		 Jan 1, 2020
Holly Wolff
Individual 		Corporate Officer
Ceo		 Jan 6, 2025
W-2 Managing Employee
Ceo		 Jan 6, 2025
Chance Klasek
Individual 		Corporate Officer
Cfo		 Aug 26, 2013
W-2 Managing Employee
Cfo		 Aug 26, 2013

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jefferson Community Health & Life Gardenside
Fairbury, NE · CCN 285282		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 25, 2009
Dec 26, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071108000030 NE Part a Provider - Critical Access Hospital 2668574542 Receives reassigned benefits from 1 practitioner
Practice locations: Fairbury, NE

National Provider Directory

Tax ID family
Jefferson Co Mem Hosp Inc (6 organizations share this tax ID)

Locations

2200 H St
#277
Fairbury, NE 68352
Phone (402) 729-3351

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 440001 NE Yes

Addresses

Primary practice location

2200 H St
Box 277
Fairbury, NE 68352-1119

Mailing address

2200 H St
PO Box 277
Fairbury, NE 68352-1119
Phone (402) 729-3351

Other names

  • Jefferson Community Health Center Doing business as

Other providers in Fairbury, NE

All providers in Fairbury, NE · Medicare Defined Swing Bed Hospital Unit in Nebraska

Sources for this page

Verify at the official NPI Registry.