NPIMap

Organization Active NPI

Jefferson Community Health Center, Inc.

Doing business as Jefferson Community Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Fairbury, NE
National Provider Identifier
1992808372
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
440001 Issued in NE
Legal business name
JEFFERSON COMMUNITY HEALTH CENTER, INC.
Doing business as
Jefferson Community Health Center
Practice address
2200 H St
Box 277
Fairbury, NE 68352-1119
Phone
(402) 729-3351
Fax
(402) 729-2102
NPI assigned
Sep 7, 2006
Last updated
Jun 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Jefferson Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992808372. Details of each certification follow.

Hospital certification: CCN 28Z319

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

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
Jefferson Community Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

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
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 DirectorVice Chairman Jan 1, 2020
Holly Wolff Individual Corporate OfficerCeo Jan 6, 2025
W-2 Managing EmployeeCeo Jan 6, 2025
Chance Klasek Individual Corporate OfficerCfo Aug 26, 2013
W-2 Managing EmployeeCfo 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 GardensideFairbury, NE, CCN 285282 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 25, 2009
Dec 26, 2024

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1992808372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 H ST",
            "address_2": "PO BOX 277",
            "city": "FAIRBURY",
            "state": "NE",
            "postal_code": "683521119",
            "telephone_number": "402-729-3351",
            "fax_number": "402-729-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 H ST",
            "address_2": "BOX 277",
            "city": "FAIRBURY",
            "state": "NE",
            "postal_code": "683521119",
            "telephone_number": "402-729-3351",
            "fax_number": "402-729-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "JURGENS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "402-729-3351"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NE",
            "license": "440001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairbury, NE

Sources for this page

Verify at the official NPI Registry.