Individual provider Active NPI

Stella G Washington, P.A.-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1043321573
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001508 Issued in IA
Practice address
4920 South 30TH Street
Suite 103
Omaha, NE 68107-1656
Phone
(402) 734-4110
Fax
(402) 991-5642
NPI assigned
Aug 31, 2006
Last updated
Nov 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001508 IA Primary
Physician Assistant 363A00000X 760 NE

Addresses

Primary practice location

4920 South 30TH Street
Suite 103
Omaha, NE 68107-1656

Mailing address

4920 South 30TH Street
Suite 103
Omaha, NE 68107-1656
Phone (402) 734-4110

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
I20080714000592 NE Practitioner - Physician Assistant 0648343384 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3908 N 138TH St
Omaha, NE 68164-5009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
760NEMDPhysical Therapy Assistant
001508IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oneworld Community Health Centers, Inc. CurrentSince Mar 23, 2016 Accepting new patients
Oneworld Community Health Centers, Inc. CurrentSince Mar 23, 2016 Accepting new patients
Heartland Emergicare, P.C. PastSince Oct 5, 2021 Accepting new patients
Joshua Medical Centers LLC Past Accepting new patients

Locations

4920 S 30th St
Ste 103
Omaha, NE 68107

Organizations & group practices 6

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1043321573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 SOUTH 30TH STREET",
            "address_2": "SUITE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071656",
            "telephone_number": "402-734-4110",
            "fax_number": "402-991-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 SOUTH 30TH STREET",
            "address_2": "SUITE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071656",
            "telephone_number": "402-734-4110",
            "fax_number": "402-991-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "STELLA",
        "middle_name": "G",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001508",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "760",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.