Individual provider Active NPI

Jennifer J Trebil, PAC

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1407817596
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1179 Issued in NE
Practice address
1120 N 103Rd PLZ
Suite 100
Omaha, NE 68114-1114
Phone
(402) 391-5055
Fax
(402) 391-5053
NPI assigned
Mar 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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 1179 NE Primary

Addresses

Primary practice location

1120 N 103Rd PLZ
Suite 100
Omaha, NE 68114-1114

Mailing address

PO Box 3755
Omaha, NE 68103-0755
Phone (402) 354-2100

Other identifiers 2

IdentifierTypeStateIssuer
1407817596MedicaidIA
100264481-00MedicaidNE

Other names 1

  • Jennifer J Woltkamp Other 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
I20050303001071 NE Practitioner - Physician Assistant 8820042609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

10060 Regency Cir
Omaha, NE 68114-3732
Phone (402) 354-1570

1120 N 103Rd Plaza
200 Cardiothoracic Surgery
Omaha, NE 68114-1119
Phone (402) 354-0400

1120 N 103Rd PLZ
Omaha, NE 68114-1119

8303 Dodge St
Omaha, NE 68114-4108
Phone (402) 354-8163

8901 W Dodge Rd
Omaha, NE 68114-3327
Phone (402) 390-1200

Hospital & facility affiliations

  • The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1179NEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Physician Assistant CurrentSince Dec 31, 2014 Accepting new patients
Nebraska Methodist Hospital Physician Assistant CurrentSince Apr 13, 2020 Accepting new patients

Locations

426 E 22nd St
Ste 100
Fremont, NE 68025
Phone (402) 727-7796

10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

1120 N 103rd Plz
Ste 100
Omaha, NE 68114
Phone (402) 391-5055

8303 Dodge St
Ste LL6
Omaha, NE 68114
Phone (402) 354-4104

6901 N 72nd St
Ste 3300N
Omaha, NE 68122
Phone (402) 572-3300

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 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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434067200000",
    "number": "1407817596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3755",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681030755",
            "telephone_number": "402-354-2100",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N 103RD PLZ",
            "address_2": "SUITE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681141114",
            "telephone_number": "402-391-5055",
            "fax_number": "402-391-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREBIL",
        "first_name": "JENNIFER",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-29",
        "last_updated": "2015-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407817596",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100264481-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WOLTKAMP",
            "middle_name": "J",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.