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Pine Lake Health LLC

Family Medicine Physician in Waverly, NE · enumerated 2009 · authorized official Matthew Glenn, Physician.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1780814475

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Registry record

Entity type Organization (Type 2)
Legal business name Pine Lake Health LLC
Other name <Unavail>
Parent organization Pine Lake Health, LLC
Practice address 13220 Callum Dr, Ste 4, Waverly, NE, 68462
Phone (402) 786-5563
Fax (402) 423-4201
Enumeration date Jul 16, 2009
Last updated in NPPES Aug 30, 2022

Taxonomy & classification

207Q00000X Family Medicine Physician Allopathic & Osteopathic Physicians Primary
363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Secondary
363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary

Authorized official

Name Matthew Glenn
Title Physician
Phone (402) 423-4200

Other identifiers

Identifier Type State Issuer
10025748100 Medicaid NE -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What type of organization is Pine Lake Health LLC?
Pine Lake Health LLC is registered in NPPES as a Family Medicine Physician (its primary provider taxonomy).
What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2022-08-30.