Individual provider Active NPI

Kimberly L Nelson, PA-C

  • Surgical Physician Assistant
  • Omaha, NE
National Provider Identifier
1396771952
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
8005 Farnam Dr Ste 305
Omaha, NE 68114-3426
Phone
(402) 390-4111
Fax
(402) 390-4115
NPI assigned
Jun 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426

Mailing address

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426
Phone (402) 390-4111

Other identifiers 2

IdentifierTypeStateIssuer
P00408000OtherRR MEDICARE
38661OtherNEBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060426000821 NE Practitioner - Physician Assistant 7719997303 Reassigns benefits to 1 organization
I20110118000186 IA Practitioner - Physician Assistant 7719997303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MD West One PCGroup PAC ID 0446228852, 89 clinicians

Practice addresses (Care Compare)

8005 Farnam Dr
Suite 305
Omaha, NE 68114-3426
Phone (402) 390-4111

Hospital & facility affiliations

  • The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040
  • Midwest Surgical Hospital LLC Hospital, Omaha, NE, CCN 280131
  • Methodist Fremont Health Hospital, Fremont, NE, CCN 280077

Merit-based Incentive Payment System (MIPS)

Final score
84.57 of 100Reported as group
Quality
76.1
Promoting interoperability
95
Improvement activities
40
Cost
76.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1261NEMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
MD West One, PC Surgical CurrentSince Mar 28, 2006 Accepting new patients
MD West One, PC CurrentSince Mar 28, 2006 Accepting new patients

Locations

1 Edmundson Pl
Ste 200
Council Bluffs, IA 51503
Phone (712) 243-3250

2959 US Highway 275
Hamburg, IA 51640
Phone 71238215158070

222 N 192nd St
Elkhorn, NE 68022

8005 Farnam Dr
Ste 305
Omaha, NE 68114

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.

Hospital & facility affiliations 4

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1396771952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8005 FARNAM DR STE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143426",
            "telephone_number": "402-390-4111",
            "fax_number": "402-390-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8005 FARNAM DR STE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143426",
            "telephone_number": "402-390-4111",
            "fax_number": "402-390-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00408000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "38661",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.