Active NPI
Pamela Mae Pedersen, LADC
- Addiction (Substance Use Disorder) Counselor
- York, NE
National Provider Identifier
1114007259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 326
- Practice address
- 722 S Lincoln Ave
Suite 1
York, NE 68467-4216 - Phone
- (402) 362-6128
- Fax
- (402) 362-7012
- NPI assigned
- Oct 16, 2006
- Last updated
- Aug 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 326 | NE | Primary |
Addresses
Primary practice location
722 S Lincoln Ave
Suite 1
York, NE 68467-4216
Mailing address
71 Kuester Lake
Grand Island, NE 68801
Phone (308) 382-5356
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47052851509 | Medicaid | NE | |
| 47052851517 | Medicaid | NE | |
| 47052851582 | Medicaid | NE | |
| 85276 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 326 | NE | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Valley Behavioral Health Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Beatrice, NE
- NPI 1316019508
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187568000000",
"number": "1114007259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 KUESTER LAKE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "68801",
"telephone_number": "308-382-5356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "722 S LINCOLN AVE",
"address_2": "SUITE 1",
"city": "YORK",
"state": "NE",
"postal_code": "684674216",
"telephone_number": "402-362-6128",
"fax_number": "402-362-7012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "PAMELA",
"middle_name": "MAE",
"name_prefix": "Mrs.",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": "326",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851509",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851517",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851582",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "85276",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in York, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.