Individual provider Active NPI

Isabella Ann Phillips, PA

  • Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1073232344
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
412 Forest Glen Dr
Council Bluffs, IA 51503-8465
Phone
(712) 308-4459
NPI assigned
Aug 22, 2022
Last updated
Aug 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

412 Forest Glen Dr
Council Bluffs, IA 51503-8465

Mailing address

412 Forest Glen Dr
Council Bluffs, IA 51503-8465
Phone (712) 308-4459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 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
I20221123000731 NE Practitioner - Physician Assistant 7416325410 Reassigns benefits to 1 organization
I20221123000772 IA Practitioner - Physician Assistant 7416325410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, shared by 2 NPIs, 951 clinicians

Practice addresses (Care Compare)

11111 S 84TH St
Papillion, NE 68046-4122
Phone (402) 898-2520

16909 Lakeside Hills CT
Omaha, NE 68130-4661

6901 N 72ND St
Omaha, NE 68122-1709

6901 N 72ND St
Suite 3300
Omaha, NE 68122-1752
Phone (402) 398-5880

7500 Mercy Rd
Omaha, NE 68124-2319
Phone (402) 398-5580

800 Mercy Dr
Council Bluffs, IA 51503-3128

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2823NEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Nov 15, 2022 Accepting new patients
Alegent Creighton Clinic Physician Assistant Past Accepting new patients

Locations

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

Organizations & group practices 3

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 6

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": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1073232344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 FOREST GLEN DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515038465",
            "telephone_number": "712-308-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 FOREST GLEN DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515038465",
            "telephone_number": "712-308-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "ISABELLA",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.