Active NPI
Peggy Joli Reynolds Hall, L.C.S.W.
- Clinical Social Worker
- Omaha, NE
National Provider Identifier
1427090034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 269
- Practice address
- 12728 Augusta Ave
Omaha, NE 68144-3753 - Phone
- (402) 330-1537
- Fax
- (402) 330-9331
- NPI assigned
- Jun 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 849 | NE | |
| Clinical Social Worker | 1041C0700X | 269 | NE | Primary |
Addresses
Primary practice location
12728 Augusta Ave
Omaha, NE 68144-3753
Mailing address
12728 Augusta Ave
Omaha, NE 68144-3753
Phone (402) 330-1537
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120644000 | Other | NE | MAGELLAN |
| 470789060000 | Medicaid | NE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 269 | NE | MD | Mental Health Counselor |
| 269 | KS | MD | Behavioral Analyst |
| 849 | NE | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345680000000",
"number": "1427090034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12728 AUGUSTA AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681443753",
"telephone_number": "402-330-1537",
"fax_number": "402-330-9331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12728 AUGUSTA AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681443753",
"telephone_number": "402-330-1537",
"fax_number": "402-330-9331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS HALL",
"first_name": "PEGGY",
"middle_name": "JOLI",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-11",
"last_updated": "2012-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NE",
"license": "849",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "269",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "120644000",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "470789060000",
"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 Aug 23, 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.