NPIMap

Individual provider Active NPI

Jessica McCool, M.D.

  • Family Medicine Physician
  • Council Bluffs, IA
National Provider Identifier
1053600296
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41619 Issued in IA
Practice address
1 Edmundson PL
Council Bluffs, IA 51503-4658
Phone
(712) 396-4340
Fax
(712) 396-4180
NPI assigned
Mar 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PENDING
Family Medicine Physician 207Q00000X 41619 IA Primary

Addresses

Primary practice location

1 Edmundson PL
Council Bluffs, IA 51503-4658

Mailing address

PO Box 3755
Omaha, NE 68103-0755
Phone (402) 354-2100

Other identifiers 2

IdentifierTypeStateIssuer
1053600296MedicaidIA
47068731712MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140616001000 IA Practitioner - Family Practice 8628292596 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
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

808 E Pierce St
Methodist Physicians Clinic
Council Bluffs, IA 51503-4652
Phone (712) 396-4360

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
41619IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nebraska Methodist Hospital Current Accepting new patients
Physicians Clinic Inc Family Medicine CurrentSince Jul 31, 2014 Accepting new patients

Locations

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

1001 Risen Son Blvd
Council Bluffs, IA 51503
Phone (712) 256-8600

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

808 E Pierce St
Council Bluffs, IA 51503
Phone (712) 396-4340

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

Interoperability endpoints

  • Direct secure messaging: jessica.mccool@direct.nmhs.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Midlands Living Center LLCCouncil Bluffs, IA, CCN 165447 Skilled nursing facility Contracted Managing Employee
Adp of the SNF		 Apr 1, 2023
Dec 17, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411516800000",
    "number": "1053600296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3755",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681030755",
            "telephone_number": "402-354-2100",
            "fax_number": "402-354-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EDMUNDSON PL",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034658",
            "telephone_number": "712-396-4340",
            "fax_number": "712-396-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOOL",
        "first_name": "JESSICA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2014-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "41619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053600296",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731712",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.