Active NPI
Kevin Everett Fitzmaurice, M.S.
- Mental Health Counselor
- Omaha, NE
National Provider Identifier
1194742817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 745
- Practice address
- 3323 N 109TH PLZ
Omaha, NE 68164-2908 - Phone
- (402) 573-7277
- Fax
- (402) 573-7360
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 745 | NE | Primary |
| Mental Health Counselor | 101YM0800X | 00050 | IA |
Addresses
Primary practice location
3323 N 109TH PLZ
Omaha, NE 68164-2908
Mailing address
3323 N 109TH PLZ
Omaha, NE 68164-2908
Phone (402) 573-7277
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00050 | Other | IA | LICENSED MENTAL HEALTH |
| 33408 | Other | NE | CCMHC |
| 33408 | Other | NE | NCC |
| 10025178600 | Medicaid | NE | |
| 745 | Other | NE | MENTAL HEALTH PRACTITIONE |
| 800 | Other | NE | CERTIFIED PROFESSIONAL CO |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00050 | IA | MD | Mental Health Counselor |
| 745 | NE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1194742817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3323 N 109TH PLZ",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642908",
"telephone_number": "402-573-7277",
"fax_number": "402-573-7360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3323 N 109TH PLZ",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642908",
"telephone_number": "402-573-7277",
"fax_number": "402-573-7360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZMAURICE",
"first_name": "KEVIN",
"middle_name": "EVERETT",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "745",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "00050",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MENTAL HEALTH",
"identifier": "00050",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCMHC",
"identifier": "33408",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCC",
"identifier": "33408",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025178600",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTAL HEALTH PRACTITIONE",
"identifier": "745",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED PROFESSIONAL CO",
"identifier": "800",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.