Individual provider Active NPI

Mariya A Kovaleva, RN, PHD, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1275293540
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
113558 Issued in NE
Practice address
730 S 38TH Ave
Omaha, NE 68105-1107
Phone
(402) 559-9600
NPI assigned
Dec 28, 2021
Last updated
Dec 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 113558 NE Primary
Primary Care Nurse Practitioner 363LP2300X 113558 NE
Registered Nurse 163W00000X 92715 NE

Addresses

Primary practice location

730 S 38TH Ave
Omaha, NE 68105-1107

Mailing address

985330 Nebraska Medical Ctr Ofc 50113
Omaha, NE 68198-5330
Phone (402) 559-6548

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220616000126 NE Practitioner - Nurse Practitioner 1850770124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Emory University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

730 S 38TH Ave
Unmc Physicians Home Instead Center for Suc
Omaha, NE 68105-1107
Phone (402) 559-9600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy, Registered Nurse

State licenses

LicenseStateTypeSpecialty
92715NEMDRegistered Nurse
113558NEMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Unmc Physicians CurrentSince Jun 2, 2022 Accepting new patients

Locations

730 S 38th Ave
Omaha, NE 68105
Phone (402) 559-9600

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-1010

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

Interoperability endpoints

  • Direct secure messaging: mkovaleva389094@direct.nebraskamed.com

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1275293540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985330 NEBRASKA MEDICAL CTR OFC 50113",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681985330",
            "telephone_number": "402-559-6548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 S 38TH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681051107",
            "telephone_number": "402-559-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVALEVA",
        "first_name": "MARIYA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "RN, PHD, AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NE",
            "license": "113558",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NE",
            "license": "113558",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NE",
            "license": "92715",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.