NPIMap

Organization Active NPI

Midwest Pain Clinic PC

  • Interventional Pain Medicine Physician
  • Omaha, NE
National Provider Identifier
1043482094
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
MIDWEST PAIN CLINIC PC
Practice address
825 N 90TH St
Omaha, NE 68114-2702
Phone
(402) 391-7246
Fax
(402) 408-1783
NPI assigned
Mar 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Maureen E Mahoney
Title
Credentialing Specialist
Phone
(402) 391-7246

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

825 N 90TH St
Omaha, NE 68114-2702

Mailing address

825 N 90TH St
Omaha, NE 68114-2706
Phone (402) 391-7246

Other practice location 1

211 Sioux Point Rd Ste 200
Dakota Dunes, SD 57049-5492
Phone (605) 242-3456

Other practice location 2

4508 38th St
Coulumbus, NE 68601-1668
Phone (402) 564-7118

Other practice location 3

2206 Longo Dr #211
Bellevue, NE 68005-2977
Phone (402) 292-9170

Other practice location 4

631 N. 8th St
Missouri Valley, IA 51555-1102
Phone (712) 642-2784

Other practice location 5

2301 Eastern Ave.
Red Oak, IA 51566-1300
Phone (402) 391-7246

Other practice location 6

9850 Nicholas St
Omaha, NE 68114-2186
Phone (402) 391-7246

Other identifiers 3

IdentifierTypeStateIssuer
263940MedicaidIA
NA1054MedicaidNE
S104099MedicaidSD

Other names 1

  • Advanced Spine And Joint Care of Nebraska Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, SD, IA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20080521000424 NE Part B Supplier - Clinic/Group Practice 5597834291 Receives reassigned benefits from 15 practitioners
Practice locations: Columbus, NE; Omaha, NE
O20100709000062 SD Part B Supplier - Clinic/Group Practice 5597834291 Receives reassigned benefits from 4 practitioners
Practice locations: Dakota Dunes, SD
O20160414000509 NE DME Supplier - Physician - Interventional Pain Management 5597834291 Practice locations: Omaha, NE
O20171110000670 IA Part B Supplier - Clinic/Group Practice 5597834291 Receives reassigned benefits from 5 practitioners
Practice locations: Missouri Valley, IA; Red Oak, IA

National Provider Directory

National Provider Directory

Locations

965 S 27th St
Lincoln, NE 68510
Phone (402) 391-7246

101 Tower Rd
Ste 103
North Sioux City, SD 57049
Phone (605) 232-5792

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JGBJBD
  • FHIR API: https://api.platform.athenahealth.com/8703/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1043482094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142706",
            "telephone_number": "402-391-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142702",
            "telephone_number": "402-391-7246",
            "fax_number": "402-408-1783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 Sioux Point Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Dakota Dunes",
            "state": "SD",
            "postal_code": "570495492",
            "country_code": "US",
            "telephone_number": "605-242-3456",
            "fax_number": "605-540-0187",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4508 38th St",
            "address_purpose": "LOCATION",
            "city": "Coulumbus",
            "state": "NE",
            "postal_code": "686011668",
            "country_code": "US",
            "telephone_number": "402-564-7118",
            "fax_number": "402-391-1302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2206 Longo Dr #211",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "NE",
            "postal_code": "680052977",
            "country_code": "US",
            "telephone_number": "402-292-9170",
            "fax_number": "402-391-1302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "631 N. 8th St",
            "address_purpose": "LOCATION",
            "city": "Missouri Valley",
            "state": "IA",
            "postal_code": "515551102",
            "country_code": "US",
            "telephone_number": "712-642-2784",
            "fax_number": "402-391-1302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 Eastern Ave.",
            "address_purpose": "LOCATION",
            "city": "Red Oak",
            "state": "IA",
            "postal_code": "515661300",
            "country_code": "US",
            "telephone_number": "402-391-7246",
            "fax_number": "402-391-1302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9850 Nicholas St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681142186",
            "country_code": "US",
            "telephone_number": "402-391-7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDWEST PAIN CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "402-391-7246"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263940",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA1054",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S104099",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Spine And Joint Care of Nebraska",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.