NPIMap

Organization Active NPI

Prime Home Care LLC

  • Home Health Agency
  • Omaha, NE
National Provider Identifier
1023041605
Registry record updated Apr 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HHA1042 Issued in NE
Legal business name
PRIME HOME CARE LLC
Practice address
6818 Grover St
Suite 201
Omaha, NE 68106-3640
Phone
(402) 390-2492
Fax
(402) 390-9070
NPI assigned
Jul 8, 2006
Last updated
Apr 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2012

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

Authorized official

Name
Mrs. Jacqueline K Ross, MCHA
Title
Owner
Phone
(402) 390-2492

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HHA1042 NE Primary

Addresses

Primary practice location

6818 Grover St
Suite 201
Omaha, NE 68106-3640

Mailing address

6818 Grover St
Suite 201
Omaha, NE 68106-3640
Phone (402) 390-2492

Other identifiers 1

IdentifierTypeStateIssuer
10025193300MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041011000602 NE Part A Provider - Home Health Agency 3072573484 Practice locations: Omaha, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023041605. Details of each certification follow.

Home health agency certification: CCN 287123

Legal name
PRIME HOME CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 2, 2004
Last certification
Oct 20, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Sep 23, 2004 in NE
Enrollment address
6818 Grover St
Ste 101
Omaha, NE 68106-3632

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prime Home CareCCN 287123 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Dec 2, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

6818 Grover St
Ste 201
Omaha, NE 68106
Phone (402) 390-2492

6818 Grover St
Ste 304
Omaha, NE 68106
Phone (402) 390-2492

7253 Grover St
Omaha, NE 68124
Phone (402) 390-2492

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tammy J Kirsch Individual W-2 Managing EmployeeAdministrator Sep 23, 2004
Jacqueline Kay Ross Individual 5% Or Greater Direct Ownership Interest Sep 23, 2004 100%
Corporate OfficerPresident Sep 23, 2004

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334880000000",
    "number": "1023041605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6818 GROVER ST",
            "address_2": "SUITE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681063640",
            "telephone_number": "402-390-2492",
            "fax_number": "402-390-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6818 GROVER ST",
            "address_2": "SUITE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681063640",
            "telephone_number": "402-390-2492",
            "fax_number": "402-390-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2012-04-20",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-390-2492",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MCHA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NE",
            "license": "HHA1042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025193300",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.