Stephanie R Revord, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

F141666 Issued in IA

Practice address

201 Ridge St Ste 312
Council Bluffs, IA 51503-4643

Phone

(712) 396-7880

Fax

(712) 396-7885

NPI assigned

Sep 23, 2015

Last updated

Jul 3, 2019By the provider in NPPES

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 3

Other names 1

• Stephanie R Lee Former name

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

University of Nebraska College of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
• The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Physicians Clinic Inc

  dba Methodist Physicians Clinic

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1821049156

  IA, Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• MP-CC PC

  dba Midwest Pulmonary Critical Care PC

  • Pulmonary Disease Physician
  • Omaha, NE
  • NPI 1033226477
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jennie Edmundson Memorial Hospital

  dba Methodist Jennie Edmundson

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1457448755
  Care Compare affiliation
• Nebraska Methodist Hospital

  dba Methodist Hospital

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1427147883
  Care Compare affiliation

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1174992846",
    "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": "201 RIDGE ST STE 312",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-396-7880",
            "fax_number": "712-396-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVORD",
        "first_name": "STEPHANIE",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-23",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IA",
            "license": "F141666",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "F141666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026211300",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026480117",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174992846",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "LEE",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kayden L Reilly, PA-C
• Rem Iowa Community Services, Inc
• Rem Iowa, Inc
• Michael Anthony Rensch, DDS
• Janet Reuter, M.D.
• David Michael Reynolds II, LPN
• Aushnee Rhodes, PLADC
• Nancy Katherine Rhodes, O.D.
• Sandra Jean Rhodes
• Eric C Rice, M.D.

• Nurse Practitioner in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.
• 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.