Active NPI
Connie L Anderson, PA-C
- Medical Physician Assistant
- Omaha, NE
National Provider Identifier
1386651172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 640
- Practice address
- 105 N 31St Ave
Ste 102
Omaha, NE 68131-2940 - Phone
- (402) 346-1111
- Fax
- (402) 408-0004
- NPI assigned
- Aug 2, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 640 | NE | Primary |
Addresses
Primary practice location
105 N 31St Ave
Ste 102
Omaha, NE 68131-2940
Mailing address
105 N 31St Ave
Ste 102
Omaha, NE 68131-2940
Phone (402) 346-1111
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37956 | Other | NE | BCBS |
| 970015303 | Other | RAILROAD MEDICARE | |
| 810 | Other | NE | MIDLANDS |
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 |
|---|---|---|---|
| 640 | NE | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Linc Care, a Joint Venture | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334793600000",
"number": "1386651172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 N 31ST AVE",
"address_2": "STE 102",
"city": "OMAHA",
"state": "NE",
"postal_code": "681312940",
"telephone_number": "402-346-1111",
"fax_number": "402-408-0004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 N 31ST AVE",
"address_2": "STE 102",
"city": "OMAHA",
"state": "NE",
"postal_code": "681312940",
"telephone_number": "402-346-1111",
"fax_number": "402-408-0004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "CONNIE",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2012-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NE",
"license": "640",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "37956",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970015303",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS",
"identifier": "810",
"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 Apr 19, 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.