NPIMap

Organization Active NPI

Alegent Creighton Health

  • Community/Retail Pharmacy
  • Bellevue, NE
National Provider Identifier
1083700959
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2807 Issued in NE
Legal business name
ALEGENT CREIGHTON HEALTH
Practice address
3308 Samson Way Ste 106a
Bellevue, NE 68123-3235
Phone
(402) 291-5076
Fax
(402) 293-9464
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Authorized official

Name
Mike Tiesi
Title
Senior Director of Pharmacy
Phone
(402) 343-4546

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 2807 NE Primary

Addresses

Primary practice location

3308 Samson Way Ste 106a
Bellevue, NE 68123-3235

Mailing address

3308 Samson Way Ste 106a
Bellevue, NE 68123-3235
Phone (402) 291-5076

Other identifiers 4

IdentifierTypeStateIssuer
10026519106MedicaidNE
2807OtherNENEBRASKA COMMUNITY PHARMACY PERMIT
4704OtherIALICENSE
0204528MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160202001309 NE Part B Supplier - Mass Immunization (Roster Biller Only) 1850285255 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Omaha, NE; Papillion, NE; Lincoln, NE; Lavista, NE; Grand Island, NE; Elkhorn, NE; Bellevue, NE
O20170118000577 NE DME Supplier - Pharmacy 1850285255 Practice locations: Bellevue, NE

Other NPIs on the same Medicare enrollment 14

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

View all 14

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CHI Health Pharmacy - Bellevue3308 Samson Way, Bellevue, NE 68123-3235(402) 291-5076 Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Surgical Dressings Accepts assignmentParticipating since Jan 1, 1997

National Provider Directory

National Provider Directory
Tax ID family
Alegent Health32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Member of 5

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3308 Samson Way
Ste 106
Bellevue, NE 68123
Phone (402) 291-5076

3308 Samson Way
Ste 106A
Bellevue, NE 68123
Phone (402) 291-5076

Ownership & related parties

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Thayer County Health ServicesHebron, NE, CCN 281304 Hospital Operational/Managerial Control Jul 29, 2016
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Other Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Other Apr 1, 2002
Nebraska Spine Hospital LLCOmaha, NE, CCN 280133 Hospital 5% Or Greater Direct Ownership Interest (51%) Apr 5, 2010
Thayer County Health ServicesHebron, NE, CCN 28Z304 Hospital Operational/Managerial Control Jul 29, 2016
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 Rural health clinic Other Apr 1, 2002
Davenport Medical ClinicDavenport, NE, CCN 283436 Rural health clinic Operational/Managerial Control Jul 29, 2016
Hebron Medical ClinicHebron, NE, CCN 283434 Rural health clinic Operational/Managerial Control Jul 29, 2016
Deshler Medical ClinicDeshler, NE, CCN 283446 Rural health clinic Operational/Managerial Control Jul 29, 2016
Bruning Medical ClinicBruning, NE, CCN 283433 Rural health clinic Operational/Managerial Control Jul 29, 2016
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Other Apr 1, 2002
Fort Calhoun ClinicFort Calhoun, NE, CCN 288506 Rural health clinic Other Apr 1, 2002

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1083700959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 SAMSON WAY STE 106A",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681233235",
            "telephone_number": "402-291-5076",
            "fax_number": "402-293-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 SAMSON WAY STE 106A",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681233235",
            "telephone_number": "402-291-5076",
            "fax_number": "402-293-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT CREIGHTON HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "TIESI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "402-343-4546"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "2807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026519106",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA COMMUNITY PHARMACY PERMIT",
            "identifier": "2807",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4704",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0204528",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, NE

Sources for this page

Verify at the official NPI Registry.