Individual provider Active NPI

Jennifer Chavez, PA-C

  • Surgical Physician Assistant
  • Omaha, NE
National Provider Identifier
1457354789
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1136 Issued in NE
Practice address
515 N 162ND Ave Ste 300
Omaha, NE 68118-2540
Phone
(402) 354-1200
Fax
(402) 354-1205
NPI assigned
May 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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 1136 NE Primary

Addresses

Primary practice location

515 N 162ND Ave Ste 300
Omaha, NE 68118-2540

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
47073679913MedicaidNE
P00153597OtherNERAILROAD MEDICARE
47081304012MedicaidNE
37833OtherNEBCBS
68154A016OtherNETRICARE

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
I20040615001362 NE Practitioner - Physician Assistant 7113901372 Reassigns benefits to 1 organization
I20150105001302 IA Practitioner - Physician Assistant 7113901372 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2003
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)

1 Edmundson PL
Council Bluffs, IA 51503-4658
Phone (712) 396-4000

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

515 N 162ND Ave
Omaha, NE 68118-2540

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

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

933 E Pierce St
Methodist Jennie Edmundson
Council Bluffs, IA 51503-4626
Phone (712) 396-7495

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1136NEMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic Surgical CurrentSince Dec 1, 2021 Accepting new patients
Physicians Clinic Inc CurrentSince Apr 21, 2025 Accepting new patients

Locations

1 Edmundson Pl
Ste 310
Council Bluffs, IA 51503
Phone (712) 328-1801

800 Mercy Dr
Council Bluffs, IA 51503
Phone (712) 328-5000

1 Edmundson Pl
Council Bluffs, IA 51503
Phone (712) 396-4000

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

812 N 22nd St
Blair, NE 68008
Phone (402) 426-4611

13616 California St
Ste 100
Omaha, NE 68154
Phone (402) 496-5517

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

9850 Nicholas St
Ste 250
Omaha, NE 68114
Phone (402) 398-5969

515 N 162nd Ave
Ste 300
Omaha, NE 68118
Phone (402) 354-1200

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

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

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": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1457354789",
    "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": "402-354-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N 162ND AVE STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182540",
            "telephone_number": "402-354-1200",
            "fax_number": "402-354-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "JENNIFER",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-31",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NE",
            "license": "1136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47073679913",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00153597",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47081304012",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "37833",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "68154A016",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.