Jaclyn Grevengoed, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3922 Issued in NE

Practice address

13616 California St Ste 100
Omaha, NE 68154-5336

Phone

(402) 496-0404

NPI assigned

Nov 23, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Mayo Medical School, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nebraska Spine Center, LLPGroup PAC ID 9830080613, 35 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71581

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nebraska Spine Center, LLP

  • Orthopaedic Surgery of the Spine Physician
  • Omaha, NE
  • NPI 1588667950

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Lemars Physical Therapy, PLLC

  • Physical Therapy Clinic/Center
  • Le Mars, IA
  • NPI 1356556898
  NPD (past)

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

{
    "created_epoch": "1385164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1144650482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7505 COUNTRY CLUB DR",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274501",
            "telephone_number": "763-450-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13616 CALIFORNIA ST STE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681545336",
            "telephone_number": "402-496-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREVENGOED",
        "first_name": "JACLYN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-23",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "3922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47081304012",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Gresham
• Carla Jean Delassus Gress, SC.D, CCC-SLP
• Elizabeth Gress
• Anna Kristine Gressett
• Meghan Greteman, CSS
• Mikayla K Grevengoed, PA
• Jackie Grey Wilson
• Nathan Cord Grey
• Keith Grgurich
• Tia Grgurich

• Physical Therapist in Omaha, NE
• Providers in Omaha, NE by specialty
• Physical Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.