Active NPI
Eric S Thomalla, LADC805
- Addiction (Substance Use Disorder) Counselor
- Wahoo, NE
National Provider Identifier
1174696314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 543 N Linden St
Blue Valley Behavioral Health
Wahoo, NE 68066-1960 - Phone
- (402) 443-4414
- Fax
- (402) 443-3462
- NPI assigned
- Nov 16, 2006
- Last updated
- Aug 6, 2009
- Sex
- Male
- 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 | NE | Primary |
Addresses
Primary practice location
543 N Linden St
Blue Valley Behavioral Health
Wahoo, NE 68066-1960
Mailing address
543 N Linden St
Blue Valley Behavioral Health
Wahoo, NE 68066-1960
Phone (402) 443-4414
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47052851502 | Medicaid | NE | |
| 10025208700 | Medicaid | NE | |
| 10025208000 | Medicaid | NE | |
| 47052851504 | Medicaid | NE |
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
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": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1174696314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "543 N LINDEN ST",
"address_2": "BLUE VALLEY BEHAVIORAL HEALTH",
"city": "WAHOO",
"state": "NE",
"postal_code": "680661960",
"telephone_number": "402-443-4414",
"fax_number": "402-443-3462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "543 N LINDEN ST",
"address_2": "BLUE VALLEY BEHAVIORAL HEALTH",
"city": "WAHOO",
"state": "NE",
"postal_code": "680661960",
"telephone_number": "402-443-4414",
"fax_number": "402-443-3462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMALLA",
"first_name": "ERIC",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "LADC805",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851502",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025208700",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025208000",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851504",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wahoo, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.