Individual provider Active NPI

Tessa Farnham, PA-C

  • Physician Assistant
  • Elkhorn, NE
National Provider Identifier
1386390268
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2737 Issued in NE
Practice address
1625 N 205TH St
Elkhorn, NE 68022-4885
Phone
(402) 717-0750
NPI assigned
Mar 1, 2022
Last updated
Aug 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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 2737 NE Primary

Addresses

Primary practice location

1625 N 205TH St
Elkhorn, NE 68022-4885

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311

Other practice location 1

7710 Mercy Rd Ste 3000
Omaha, NE 68124-2350
Phone (402) 717-0750

Other names 1

  • Tessa Stoltenburg Former name

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
I20220411000790 NE Practitioner - Physician Assistant 2961898473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

1625 N 205TH St
CHI Health Clinic
Elkhorn, NE 68022-4759
Phone (402) 758-5452

16909 Lakeside Hills CT
Omaha, NE 68130-4661

7500 Mercy Rd
Omaha, NE 68124-2319
Phone (402) 398-5580

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2737NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Apr 19, 2022 Accepting new patients
Alegent Creighton Clinic Physician Assistant Past Accepting new patients

Locations

1625 N 205th St
Elkhorn, NE 68022
Phone (402) 717-0750

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

7710 Mercy Rd
Ste 3000
Omaha, NE 68124
Phone (402) 717-9600

Organizations & group practices 3

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 2

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": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1386390268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 N 205TH ST",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680224885",
            "telephone_number": "402-717-0750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7710 Mercy Rd Ste 3000",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681242350",
            "country_code": "US",
            "telephone_number": "402-717-0750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FARNHAM",
        "first_name": "TESSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-01",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TESSA",
            "last_name": "STOLTENBURG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkhorn, NE

Sources for this page

Verify at the official NPI Registry.