NPIMap

Organization Active NPI

Elite Professionals Home Care LLC

  • Home Health Agency
  • Lincoln, NE
National Provider Identifier
1063433290
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HHA201604 Issued in NE
Legal business name
ELITE PROFESSIONALS HOME CARE LLC
Practice address
3901 Faulkner Dr.
Lincoln, NE 68516-4738
Phone
(402) 464-2422
Fax
(402) 464-2922
NPI assigned
Jul 22, 2006
Last updated
Nov 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Authorized official

Name
Jennifer K Gibbons, RN
Title
Owner/President
Phone
(402) 464-2422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HHA201604 NE Primary

Addresses

Primary practice location

3901 Faulkner Dr.
Lincoln, NE 68516-4738

Mailing address

3901 Faulkner Dr.
Lincoln, NE 68516-4738
Phone (402) 464-2422

Other identifiers 1

IdentifierTypeStateIssuer
10025122700MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030724000021 NE Part A Provider - Home Health Agency 1759292568 2 other NPIs on this enrollment
Practice locations: Lincoln, NE; Omaha, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063433290. Details of each certification follow.

Home health agency certification: CCN 287122

Legal name
ELITE PROFESSIONALS HOME CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 20, 2004
Last certification
Feb 11, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
3901 Faulkner Dr
Lincoln, NE 68516-4738

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Elite Professionals Home Care CompanyCCN 287122 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
May 20, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D1014721Elite Professionals Home Care3901 Faulkner Drive, Lincoln, NE 68516Certificate of waiverJul 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Elite Professionals Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Networks

  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Cheryl Abel Individual Corporate OfficerVP Oct 1, 2016
Jennifer K Gibbons Individual 5% Or Greater Indirect Ownership InterestPresident Oct 1, 2016 20.4%
Corporate OfficerPresident Jul 1, 2003
Corporate DirectorPresident Jul 1, 2003
W-2 Managing EmployeePresident Jul 1, 2003
Operational/Managerial ControlFinancial Administrator Jul 1, 2003
Curis Partners LLC Organization, Portland, OR LLC Operational/Managerial Control Aug 13, 2021 100%
Derek Gibbons Individual 5% Or Greater Indirect Ownership InterestIndirect Owner Oct 1, 2016 19.6%
Stephanie D Wiese Individual W-2 Managing EmployeePayroll Manager Jun 1, 2010
Operational/Managerial ControlFinancial Administrator Jun 1, 2010
Zafar Azimov Individual 5% Or Greater Indirect Ownership InterestIndirect Owner Oct 1, 2016 6%
Zamwell Group LLC Organization, Vancouver, WA LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2016 6%
Apex Home Health Nebraska LLC Organization, Portland, OR LLC 5% Or Greater Direct Ownership Interest Oct 1, 2016 60%
James G Adamson Individual 5% Or Greater Indirect Ownership InterestIndirect Owner Oct 1, 2016 6%
Anna J Haynes Individual Operational/Managerial Control Aug 13, 2021 10%
Gibbons Home Care Inc Organization, Lincoln, NE 5% Or Greater Direct Ownership Interest Oct 1, 2016 40%
Apex Home Health LLC Organization, Portland, OR LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2016 28.8%
Healthcare Partners 2016 Fund LLC Organization, Portland, OR LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2016 12%

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1063433290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 FAULKNER DR.",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164738",
            "telephone_number": "402-464-2422",
            "fax_number": "402-464-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 FAULKNER DR.",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164738",
            "telephone_number": "402-464-2422",
            "fax_number": "402-464-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PROFESSIONALS HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "402-464-2422",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NE",
            "license": "HHA201604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025122700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.