Individual provider Active NPI

Elizabeth Marie Jacobsma

  • Family Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1013339738
Registry record updated Apr 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
111790 Issued in NE
Practice address
7261 Mercy Rd
Omaha, NE 68124-2311
Phone
(180) 025-3436
NPI assigned
Jan 15, 2014
Last updated
Apr 8, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 111790 NE Primary

Addresses

Primary practice location

7261 Mercy Rd
Omaha, NE 68124-2311

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (180) 025-3436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160503000545 NE Practitioner - Nurse Practitioner 0446489231 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alegent Health Quick Care LLCGroup PAC ID 3476657370, 6 clinicians

Practice addresses (Care Compare)

5005 S 153Rd St
Suite 100
Omaha, NE 68137-5070
Phone (402) 717-1255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
111790NEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Health Quick Care LLC CurrentSince Apr 12, 2016 Accepting new patients
Alegent Health Quick Care LLC CurrentSince Apr 12, 2016 Accepting new patients
Alegent Creighton Clinic CurrentSince Apr 12, 2016 Accepting new patients
Alegent Creighton Clinic Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

5005 S 153rd St
Ste 100
Omaha, NE 68137
Phone (402) 614-1258

5045 S 153rd St
Omaha, NE 68137
Phone (402) 717-9100

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460073600000",
    "number": "1013339738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "180-025-3436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "180-025-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSMA",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-15",
        "last_updated": "2016-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "111790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.