Individual provider Active NPI

Ivory Laine Welbourn, LIMHP, MSW

  • Clinical Social Worker
  • Omaha, NE
National Provider Identifier
1174965792
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1125 Issued in NE
Practice address
7101 Newport Ave
Omaha, NE 68152-2164
Phone
(402) 572-2916
Fax
(402) 572-3544
NPI assigned
Jul 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1125 NE Primary

Addresses

Primary practice location

7101 Newport Ave
Omaha, NE 68152-2164

Mailing address

7101 Newport Ave
Omaha, NE 68152-2164
Phone (402) 572-2916

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131029000755 NE Practitioner - Clinical Social Worker 8628203619 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alegent Creighton HealthGroup PAC ID 1850285255, 137 clinicians

Practice addresses (Care Compare)

7101 Newport Ave
Omaha, NE 68152-2164
Phone (402) 572-2905

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1125NEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Health Clinical CurrentSince Aug 26, 2013 Accepting new patients
Alegent Creighton Health CurrentSince Aug 26, 2013 Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

7101 Newport Ave
Omaha, NE 68152
Phone (402) 572-2905

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1174965792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 NEWPORT AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681522164",
            "telephone_number": "402-572-2916",
            "fax_number": "402-572-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 NEWPORT AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681522164",
            "telephone_number": "402-572-2916",
            "fax_number": "402-572-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELBOURN",
        "first_name": "IVORY",
        "middle_name": "LAINE",
        "credential": "LIMHP, MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "1125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.