NPIMap

Organization Active NPI

Pender Community Hospital District

Doing business as PCH Professional Services

  • Family Medicine Physician
  • Pender, NE
National Provider Identifier
1992869101
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PENDER COMMUNITY HOSPITAL DISTRICT
Doing business as
PCH Professional Services
Practice address
100 Hospital Dr
Pender, NE 68047-4507
Phone
(402) 385-3083
Fax
(402) 385-1870
NPI assigned
Dec 21, 2006
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PENDER COMMUNITY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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
Physician Assistant 363A00000X NU
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

100 Hospital Dr
Pender, NE 68047-4507

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
03587OtherNEBCBSNE PROF SERVICES

Other names 1

  • PCH Professional Services Doing business as

Medicare participation

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

Enrollment records 1

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
Practice locations: Pender, NE

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.

National Provider Directory

National Provider Directory
Part of
Siouxld Radiology Partn

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1992869101",
    "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": "100 HOSPITAL DR",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680474507",
            "telephone_number": "402-385-3083",
            "fax_number": "402-385-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "enumeration_date": "2006-12-21",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNE PROF SERVICES",
            "identifier": "03587",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCH Professional Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PCH Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pender, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.