Individual provider Active NPI

Ann Marie Porter, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1053019018
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
515 N 162ND Ave Ste 300
Omaha, NE 68118-2540
Phone
(402) 354-1200
Fax
(402) 354-1205
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

515 N 162ND Ave Ste 300
Omaha, NE 68118-2540

Mailing address

515 N 162ND Ave Ste 300
Omaha, NE 68118-2540
Phone (402) 354-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230705000283 IA Practitioner - Physician Assistant 7810356169 Reassigns benefits to 1 organization
I20230713001555 NE Practitioner - Physician Assistant 7810356169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

1 Edmundson PL
Council Bluffs, IA 51503-4658
Phone (712) 396-4000

10060 Regency Cir
Omaha, NE 68114-3732
Phone (402) 354-1570

515 N 162ND Ave
Omaha, NE 68118-2540

625 S Pine St
Physicians Clinic Valley
Valley, NE 68064-4400
Phone (402) 359-2277

8303 Dodge St
Omaha, NE 68114-4108
Phone (402) 354-8163

933 E Pierce St
Methodist Jennie Edmundson
Council Bluffs, IA 51503-4626
Phone (712) 396-7495

Hospital & facility affiliations

  • The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040
  • Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
  • Methodist Fremont Health Hospital, Fremont, NE, CCN 280077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2960NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Single Specialty CurrentSince Aug 15, 2023 Accepting new patients
Nebraska Methodist Hospital Current Accepting new patients

Locations

1 Edmundson Pl
Ste 310
Council Bluffs, IA 51503
Phone (712) 328-1801

1 Edmundson Pl
Council Bluffs, IA 51503
Phone (712) 396-4000

825 S 169th St
Fl 3
Omaha, NE 68118
Phone (402) 354-5451

515 N 162nd Ave
Ste 300
Omaha, NE 68118
Phone (402) 354-1200

10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

Interoperability endpoints

  • Direct secure messaging: ann.porter@direct.nmhs.org

Organizations & group practices 2

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1053019018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N 162ND AVE STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182540",
            "telephone_number": "402-354-1200",
            "fax_number": "402-354-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N 162ND AVE STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182540",
            "telephone_number": "402-354-1200",
            "fax_number": "402-354-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.