Jenna M. Matlock, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2545 Issued in NE

Practice address

7100 W Center Rd
Omaha, NE 68106-2714

Phone

(402) 506-9000

Fax

(402) 506-9093

NPI assigned

Aug 31, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jenna M. Provance Former name

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: jmatlock148133@direct.nebraskamed.com

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.

• Harlan County Health System

  • Critical Access Hospital
  • Alma, NE
  • NPI 1124035225
  Medicare reassignment
• Think Aksarben, LLC

  • Multi-Specialty Clinic/Center
  • Omaha, NE
  • NPI 1316357676
  Medicare reassignment
• Unmc Physicians

  • Multi-Specialty Clinic/Center
  • Omaha, NE
  • NPI 1417912114
  Medicare reassignment
• Harlan County Health System

  • Rural Health Clinic/Center
  • Alma, NE
  • NPI 1538456884

  Physician Assistant

  NPD
• Radiology Consultants PC

  • Diagnostic Radiology Physician
  • Omaha, NE
  • NPI 1215969407
  NPD (past)

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1215540026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 W CENTER RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681062714",
            "telephone_number": "402-506-9000",
            "fax_number": "402-506-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 W CENTER RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681062714",
            "telephone_number": "402-506-9000",
            "fax_number": "402-506-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLOCK",
        "first_name": "JENNA",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "PROVANCE",
            "middle_name": "M.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abuk Mathok
• Abul Mathok
• Ashel Majak Mathok
• Mati Home Care LLC
• Arali Matlock
• Jodie Matlock
• Tiffany Matlock, PLMHP
• Jill Nicole Matney Bolen
• Brittany Lee Matney, DNP-FNP
• Zahily Matos Vera

• 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 Nov 24, 2020; 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.