Individual provider Active NPI

Sophie Ann Gengenbach

  • Physician Assistant
  • Papillion, NE
National Provider Identifier
1336987213
Registry record updated Mar 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
555 Fortune Dr
Papillion, NE 68046-3421
Phone
(402) 502-3600
Fax
(402) 505-3606
NPI assigned
Jul 16, 2024
Last updated
Mar 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

555 Fortune Dr
Papillion, NE 68046-3421

Mailing address

555 Fortune Dr
Papillion, NE 68046-3421
Phone (402) 502-3600

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
I20260227000895 NE Practitioner - Physician Assistant 2567943566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Papillion Family Medicine PCGroup PAC ID 2062486301, 4 clinicians

Practice addresses (Care Compare)

555 Fortune Dr
Papillion, NE 68046-3421
Phone (402) 502-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3366NEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Papillion Family Medicine P C CurrentSince Jan 22, 2026 Accepting new patients

Locations

555 Fortune Dr
Papillion, NE 68046
Phone (402) 397-7400

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 1

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": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773619200000",
    "number": "1336987213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 FORTUNE DR",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680463421",
            "telephone_number": "402-502-3600",
            "fax_number": "402-505-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 FORTUNE DR",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680463421",
            "telephone_number": "402-502-3600",
            "fax_number": "402-505-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENGENBACH",
        "first_name": "SOPHIE",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Papillion, NE

Sources for this page

Verify at the official NPI Registry.