The story begins with unease. A surgeon was partway through a difficult operation and did not have the information he wanted. The data that might sharpen the next decision was somewhere between unavailable and unusable. For Nick Luekenga, then building a career in healthcare sales and business development, that discomfort sounded less like an isolated complaint than an unfinished system.
In 2006, Luekenga founded Neuromonitoring Associates, usually shortened to NMA. The problem the company addressed was precise: during certain operations, a surgical team needs to understand what is happening to the nervous system while the work is still underway. Blood pressure and temperature already have their familiar place on the monitors. Electrical signals traveling through the brain, spinal cord, and peripheral nerves require their own instruments, trained eyes, and a clear voice when something changes.
Luekenga was not a neuroscientist arriving with a new electrode. He had earned a marketing degree from Utah State University's Jon M. Huntsman School of Business in 2004, then joined Cardinal Health in sales, management, and business development. That background matters. NMA's founding idea was technical, but the company itself had to solve a coordination problem: equipment in the room, a technologist watching it, a physician interpreting the data, and a surgeon receiving useful feedback without delay.
A signal is only useful when it can travel
Intraoperative neuromonitoring, or IONM, turns nervous-system activity into waveforms that specialists can follow during surgery. The basic chain is easy to draw and hard to execute. A signal must be captured. A trained neurotechnologist must recognize whether it has meaning. A supervising physician must provide clinical oversight. The surgical team must hear the finding in language suited to the moment.
From nervous system to decision
NMA built its service around that relay. The company pairs on-site technologists with off-site physician oversight and developed its own A.M.P. technology to make feedback clearer and more coordinated across the operating suite. The technology has changed over the years, but Luekenga's public explanation remains stubbornly human. In a 2019 industry interview, he reduced much of the job to five words: “Communication is the key here.”
“He has an incredible entrepreneurial drive.”Clint Peterson, Peterson Partners
Investor Clint Peterson describes Luekenga as someone who thinks about the people he works with and the people the organization serves. That description helps explain why NMA's mission language gives equal billing to innovation and empowered clinicians. Machinery can surface a change. Someone still has to understand it, own the judgment, and speak.
The degree on the wall says marketing
There is a charming mismatch between Luekenga's education and the vocabulary of the company he built. His degree says marketing. His daily world says EEG, EMG, NCV, cranial nerves, and neurophysiological data. The bridge is the operator's craft: learn the customer's anxiety, organize expertise around it, and make the resulting service dependable.
Sales taught him to translate value. Management taught him to develop people. Business development taught him that a technically correct service can still fail if trust, timing, or adoption breaks down. Public career records show that he remained at Cardinal Health until 2013, seven years after founding NMA. The overlap suggests a company built while its founder was still accumulating experience inside a large healthcare supplier.
His public comments rarely linger on a single device. They move among clinician training, patient advocates, communication with surgical teams, and the systems that connect them. That range is an operator's fingerprint. A piece of equipment can be purchased; a dependable service has to be rehearsed. NMA's technologists receive specialized academic and practical preparation, while its operating model adds clinical oversight and an emphasis on speaking clearly across the surgical suite. The founder's job in this arrangement is less about occupying every expert role than making sure the roles meet cleanly. Luekenga built the company around those handoffs, the small seams where a technically sound service can become either reassuring or brittle.
NMA now presents itself as a national provider with a local operating model. The company reports supporting more than 2,400 surgeons and holding contracts with more than 1,000 hospitals and health systems. It publicly identifies its workforce within the 201-to-500 employee band. These are company-reported measures, but together they show the distance between the original Las Vegas idea and today's operation.
Scale introduces a peculiar danger. The work that made a company valuable becomes trapped behind administrative work that does not. For NMA, the warning arrived as a referral inbox.
When growth becomes a pile of documents
Before NMA automated referral intake, an employee typically processed 15 to 20 referrals per day. Each email could contain records for several patients, with different forms and handwritten details. A team member might have 65 to 70 cases waiting in an inbox. The queue threatened morale and relationships with surgeon practices, because a slow referral is not an abstract process failure. It is a person waiting to move through the system.
Luekenga put the problem plainly: the existing processes could not keep pace with the scale being added. NMA introduced Tennr to classify documents and extract information from messy sources without replacing the company's entire workflow. The published results show referrals processed per day rising by 157 percent, the measured daily backlog moving from as many as 65 cases to zero, and the scheduling team shrinking to one-third of its earlier size.
The interesting result is not that software did paperwork. The interesting result is what people did next. Luekenga said employees moved toward customer-experience activities, creating better interactions with patients, referral sources, and other stakeholders. Over three years, he reported, the company tripled while its supporting administrative team stayed the same size.
There is a lesson here that travels well beyond healthcare. Automation is often sold as subtraction: fewer clicks, fewer hires, fewer minutes. Luekenga's account is more useful because it names the addition. Human attention moved from classifying documents toward relationships. The machine cleared the desk. The people returned to the part of the work that required people.
The operating advantage was not faster paperwork. It was deciding where human attention should go once the paperwork stopped asking for it.
Consistency without turning people into machinery
NMA's public materials repeat a cluster of values: compassion, accountability, adaptability, innovation, and consistency. The list is revealing. Consistency matters in a high-stakes clinical service, but adaptability sits beside it. A standardized process must still leave room for a trained person to recognize that this case, this surgeon, or this signal is different.
The company's “3 or Me” program reflects that balance. It aims to limit the number of technologists assigned to each surgeon, allowing familiarity to accumulate without making the service depend on one individual. The design turns trust into something the organization can support: a small circle, repeated collaboration, and enough redundancy to keep the work moving.
Luekenga has extended the same local logic to community service. In a LinkedIn post marking Martin Luther King Jr. Day, he wrote that NMA managers and their teams choose local service projects and that the company contributes time and money. The gesture fits his broader language about empowered employees. Central leadership supplies the commitment; local teams choose where it lands.
Twenty years in, the question is still operational
NMA marked its twentieth anniversary in 2026. The company described the milestone as the continuation of a dream built by neurotechnologists, clinical teams, partners, and practices around the country. Its stated next chapter remains familiar: more innovation, more collaboration, and continued attention to the patient.
A founder can spend twenty years answering the same question at different scales. At first, Luekenga's question concerned an operating room: how does a surgeon get a clearer signal at the right moment? Later it concerned a company: how do hundreds of clinicians deliver that service consistently? Then it concerned the office behind the clinicians: how can information move without collecting in an inbox?
The answers changed from monitoring technology to training, from team design to automation. The shape of the problem did not. Something important was trying to move through a complicated system. Luekenga's work has been to notice where it stalled, put capable people near the signal, and shorten the distance between information and action.
That is a sober kind of founder story. It contains no lightning bolt and no garage mythology. It begins with another person's discomfort. It continues through two decades of details. And somewhere inside a room filled with machines, a waveform changes, a trained person speaks, and the system does what it was built to do: pay attention.