Jack Formanek, MS, LMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

205 Issued in IA

Practice address

307 E View Dr
Council Bluffs, IA 51503-0464

Phone

(712) 325-1584

Fax

(712) 325-0546

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

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 2

Specialty

Mental Health Counselor

Education

Nebraska College of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.formanek.p1@direct.charlesdrew.nextgenshare.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.

• Charles Drew Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1255302170

  Mental Health

  Medicare reassignment NPD
• Charles Drew Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1215767421
  NPD
• Charles Drew Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
  • NPI 1386218212
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285791376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E VIEW DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515030464",
            "telephone_number": "712-325-1584",
            "fax_number": "712-325-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E VIEW DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515030464",
            "telephone_number": "712-325-1584",
            "fax_number": "712-325-0546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "JACK",
        "credential": "MS, LMHP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Focus-Family Options & Community Supports, Inc
• Foot and Ankle Center of Nebraska, P.C.
• Amy L Ford, WHNP
• Forefront Dermatology, S.C.
• Millie Foreman
• Fox Run Assisted Living
• Fox Run Assisted Living Operating, LLC
• Chelsey Fox, APRN
• Danie Frazee, PAC
• Marcy Lenore French, ARNPC

• Mental Health Counselor in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.