Jennifer R Michaelis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1825 Issued in NE

Practice address

16120 W Dodge Rd
Omaha, NE 68118-2049

Phone

(402) 354-0707

Fax

(402) 354-0711

NPI assigned

Jun 11, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NE

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmichaelis1133224@directc.mercy.net

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.

• Father Flanagan'S Boys' Home

  • Pediatrics Physician
  • Omaha, NE
  • NPI 1295821825

  Physician Assistant

  Medicare reassignment NPD
• ENT Services PC

  • Otolaryngology Physician
  • Omaha, NE
  • NPI 1194822130

  Physician Assistant

  NPD (past)
• Father Flanagan'S Boys Home

  • Psychologist
  • Boys Town, NE
  • NPI 1265405419
  NPD (past)

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1164860268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3755",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681030755",
            "telephone_number": "402-354-2100",
            "fax_number": "402-354-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16120 W DODGE RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182049",
            "telephone_number": "402-354-0707",
            "fax_number": "402-354-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHAELIS",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1825",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "074838",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731742",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731751",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Wayne Michael
• Neil Michael
• Reanen E. Michael Jr., DPM
• Stephen Burton Michael, DDS
• Janessa Michaelis, PLMHP
• Maria A Michaelis, MD
• David Michaels, O.D.
• Joel Matthew Michalski, MD, PHD
• Marc D Michel, CRNA
• Michele Dudley LMHP

• Physician Assistant in Omaha, NE
• Providers in Omaha, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.