Jordan Amber Haake, APRN
Individual provider Active NPI Family Nurse Practitioner · Gothenburg, NE
NPI 1104666734 · NPPES record last updated Jun 27, 2024
Key facts
- NPI
- 1104666734
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 115387 (NE)
- Practice address
- 910 20TH St
Gothenburg, NE 69138-1237 - Phone
- (308) 537-3661
- NPI assigned
- May 30, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gothenburg Memorial Hospital
Practice addresses (Care Compare)
910 20TH St
Gothenburg, NE 69138-1237
Phone (308) 537-3661
Hospital & facility affiliations
- Gothenburg Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240828002994 | NE | Practitioner - Nurse Practitioner | 0143769638 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115387 | NE | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gothenburg Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Gothenburg Memorial Hospital | Current |
Accepting new patients | |
| Gothenburg Memorial Hospital | Past | Accepting new patients |
Locations
918 20th St
Gothenburg, NE 69138
Phone (308) 537-4066
910 20th St
Gothenburg, NE 69138
Phone (308) 537-3661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 115387 | NE | Yes |
Addresses
Primary practice location
910 20TH St
Gothenburg, NE 69138-1237
Mailing address
1016 22ND St
Gothenburg, NE 69138-2507
Phone (308) 529-0350
Other providers in Gothenburg, NE
- Gothenburg Public Schools
- Gothenburg Senior Citizen'S Center
- Gothenburg-Cozad Vision Clinic,P.C.
- Gottenburg Senior Living, LLC
- James J. Graff
- Landen Haake
- Melissa Haas
- Randal Harouff
- Hannah Marie Harrison
- Hecox Dentistry, PC
All providers in Gothenburg, NE · Family Nurse Practitioner in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.