Individual provider Active NPI

Jill Renee Sobczyk, P.A.-C

  • Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1487783270
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
201 Ridge St
Suite 201
Council Bluffs, IA 51503-4643
Phone
(712) 322-5899
Fax
(712) 322-5730
NPI assigned
Mar 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 001791 IA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

201 Ridge St
Suite 201
Council Bluffs, IA 51503-4643

Mailing address

808 E Pierce St
Council Bluffs, IA 51503-4601
Phone (712) 396-4340

Other identifiers 3

IdentifierTypeStateIssuer
51011042OtherIASTATE CONTROLLED SUBSTANC
001791OtherIALICENSE NUMBER
1053300020OtherIAGROUP NPI NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20070606000617 IA Practitioner - Physician Assistant 7012015589 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
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

808 E Pierce St
Methodist Physicians Clinic
Council Bluffs, IA 51503-4652
Phone (712) 396-4360

Hospital & facility affiliations

  • Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
  • CHI Health Mercy Council Bluffs Hospital, Council Bluffs, IA, CCN 160028
  • The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001791IAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Physician Assistant CurrentSince Jul 1, 2023 Accepting new patients
Nebraska Methodist Hospital Current Accepting new patients

Locations

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

201 Ridge St
Ste 311
Council Bluffs, IA 51503
Phone (712) 322-5899

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

808 E Pierce St
Council Bluffs, IA 51503
Phone (712) 396-4340

201 Ridge St
Ste 201
Council Bluffs, IA 51503
Phone (712) 322-5899

825 S 169th St
Fl 3
Omaha, NE 68118
Phone (402) 354-5451

Interoperability endpoints

  • Direct secure messaging: jill.sobczyk@direct.nmhs.org

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 3

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1487783270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 E PIERCE ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034601",
            "telephone_number": "712-396-4340",
            "fax_number": "712-396-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST",
            "address_2": "SUITE 201",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5899",
            "fax_number": "712-322-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBCZYK",
        "first_name": "JILL",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "001791",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CONTROLLED SUBSTANC",
            "identifier": "51011042",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "001791",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI NUMBER",
            "identifier": "1053300020",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.