Active NPI
Andrea Kodad, PAC
- Physician Assistant
- Omaha, NE
National Provider Identifier
1316904600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 990
- Practice address
- 988102 Nebraska Medical Ctr
Omaha, NE 68198-8102 - Phone
- (402) 559-4017
- NPI assigned
- Apr 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1043 | SC | |
| Physician Assistant | 363A00000X | 990 | NE | Primary |
Addresses
Primary practice location
988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Mailing address
988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Phone (402) 559-4017
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| O354PA | Medicaid | SC | |
| 990 | Other | NE | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 990 | NE | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Father Flanagan'S Boys Home | Past | Accepting new patients | |
| Carolinas Medical Alliance, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychologist
- Boys Town, NE
- NPI 1265405419
-
- Rural Health Clinic/Center
- Pamplico, SC
- NPI 1023238490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350950400000",
"number": "1316904600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "988102 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681988102",
"telephone_number": "402-559-4017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "988102 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681988102",
"telephone_number": "402-559-4017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODAD",
"first_name": "ANDREA",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-28",
"last_updated": "2012-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "1043",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "990",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "O354PA",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "990",
"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 Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.