NPIMap

Organization Active NPI

Alegent Creighton Health

  • Community/Retail Pharmacy
  • Council Bluffs, IA
National Provider Identifier
1295293744
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ALEGENT CREIGHTON HEALTH
Practice address
1288 Valley View Drive
Pharmacy Ste 101
Council Bluffs, IA 51503-5245
Phone
(000) 000-0000
NPI assigned
Mar 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mike Tiesi, DO, RP
Title
Division VP Pharmacy
Phone
(402) 343-4546

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1288 Valley View Drive
Pharmacy Ste 101
Council Bluffs, IA 51503-5245

Mailing address

7261 Mercy Road
Attn: Carie Wilderman /South BLDG 2ND FLR
Omaha, NE 68124
Phone (402) 343-4546

Other identifiers 3

IdentifierTypeStateIssuer
PENDINGMedicaidIA
PENDINGOtherIAIOWA PHARMACY LICENSE
PENDINGOtherNENCPDP #

Other names 1

  • CHI Health Pharmacy - Valley View Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161128002447 IA Part B Supplier - Mass Immunization (Roster Biller Only) 1850285255 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Council Bluffs, IA
O20191205002661 IA DME Supplier - Pharmacy 1850285255 Practice locations: Council Bluffs, IA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0677842CHI Health Clinic Valley View1288 Valley View Dr, Suite 100, Council Bluffs, IA 51503Provider-performed microscopyJun 1, 2027
16D2116780CHI Health Clinic Women'S- Valley View1288 Valley View Dr Suite 100, Council Bluffs, IA 51503Provider-performed microscopyJul 31, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CHI Health Pharmacy Valley View1288 Valley View Dr, Council Bluffs, IA 51503-5245(712) 242-2405 Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Surgical Dressings Accepts assignmentParticipating since Jan 1, 1997

National Provider Directory

National Provider Directory
Tax ID family
Alegent Health32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

7261 Mercy Rd
Bldg 2ND
Omaha, NE 68124

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Thayer County Health ServicesHebron, NE, CCN 281304 Hospital Operational/Managerial Control Jul 29, 2016
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Other Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Other Apr 1, 2002
Nebraska Spine Hospital LLCOmaha, NE, CCN 280133 Hospital 5% Or Greater Direct Ownership Interest (51%) Apr 5, 2010
Thayer County Health ServicesHebron, NE, CCN 28Z304 Hospital Operational/Managerial Control Jul 29, 2016
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 Rural health clinic Other Apr 1, 2002
Davenport Medical ClinicDavenport, NE, CCN 283436 Rural health clinic Operational/Managerial Control Jul 29, 2016
Hebron Medical ClinicHebron, NE, CCN 283434 Rural health clinic Operational/Managerial Control Jul 29, 2016
Deshler Medical ClinicDeshler, NE, CCN 283446 Rural health clinic Operational/Managerial Control Jul 29, 2016
Bruning Medical ClinicBruning, NE, CCN 283433 Rural health clinic Operational/Managerial Control Jul 29, 2016
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Other Apr 1, 2002
Fort Calhoun ClinicFort Calhoun, NE, CCN 288506 Rural health clinic Other Apr 1, 2002

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1295293744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY ROAD",
            "address_2": "ATTN: CARIE WILDERMAN /SOUTH BLDG 2ND FLR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68124",
            "telephone_number": "402-343-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1288 VALLEY VIEW DRIVE",
            "address_2": "PHARMACY STE 101",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515035245",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT CREIGHTON HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-04",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "TIESI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "DIVISION VP PHARMACY",
        "authorized_official_telephone_number": "402-343-4546",
        "authorized_official_credential": "DO, RP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA PHARMACY LICENSE",
            "identifier": "PENDING",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "PENDING",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Pharmacy - Valley View",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.