Active NPI
Patrick McClaughry, PA-C
- Surgical Physician Assistant
- Omaha, NE
National Provider Identifier
1295739159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 882
- Practice address
- 13616 California St
Ste 100
Omaha, NE 68154-5335 - Phone
- (402) 496-0404
- Fax
- (402) 496-0517
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 882 | NE | Primary |
Addresses
Primary practice location
13616 California St
Ste 100
Omaha, NE 68154-5335
Mailing address
13616 California St
Ste 100
Omaha, NE 68154-5335
Phone (402) 496-0404
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34831 | Other | NE | BCBS |
| 970012362 | Other | NE | RAILROAD MEDICARE |
| 47081304012 | Medicaid | NE | |
| 68154A019 | Other | NE | TRICARE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100315000194 | NE | Practitioner - Physician Assistant | 6103951371 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 882 | NE | MD | Speech-Language Pathologist |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233100800000",
"number": "1295739159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13616 CALIFORNIA ST",
"address_2": "STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681545335",
"telephone_number": "402-496-0404",
"fax_number": "402-496-0517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13616 CALIFORNIA ST",
"address_2": "STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681545335",
"telephone_number": "402-496-0404",
"fax_number": "402-496-0517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLAUGHRY",
"first_name": "PATRICK",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2009-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NE",
"license": "882",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "34831",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970012362",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47081304012",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "68154A019",
"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 Jan 28, 2009; 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.