Bellevue Primary Healthcare PC
Organization Active NPI Family Medicine Physician · Bellevue, NE
NPI 1497091888 · NPPES record last updated Apr 24, 2024
Key facts
- NPI
- 1497091888
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BELLEVUE PRIMARY HEALTHCARE PC
- Practice address
- 12717 S 28TH Ave
Bellevue, NE 68123-3232 - Phone
- (402) 525-6976
- NPI assigned
- Dec 12, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kelli Rae Pavlish, APRN
- Title
- Nurse Practitioner
- Phone
- (402) 525-6976
Practitioners 49
-
Christine Allen, PLMHP
-
Alliea Ann Bice, LIMHP, LMHP, CPC
-
Jungwon Cho, MS, PLMHP, PLADC
-
Jennifer Lee Coleman, LIMHP
-
Andrea Dawn Degner, LIMHP, LMHP, LICSW
-
Katherine Mary Eisenbeil, LIMHP
-
Daniel G Fender, LICSW
-
Valerie Lynn Height, LCSW, LMHP
-
Sharon Hughbanks, LIMHP, LADC
-
Rose Sharan Kern, MAMT, MT-BC, PLMHP
-
Rebecca L. Newberry, RN, MS, CDE, APRN
-
Cassandra Marie Parker, LIMHP
-
Kelli R. Pavlish, NP
-
Christine Elizabeth Salvatore, M.S., LIMHP, LMFT
-
Kyleen Schmoker, NP
-
Kerry L Takeda, APRN
-
Lori S. Terryberry-Spohr, PH.D.
-
Kelly Lynn Thelen, APRN
-
Robert Langenfeld, M.D.
-
Brandi L Hensley, PA
-
Jessica Freeman-Krieger, LMHP, CMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130507000450 | NE | Part B Supplier - Clinic/Group Practice | 2860639051 |
Receives reassigned benefits from 37 practitioners Practice locations: Omaha, NE; Bellevue, NE |
| O20221020001334 | AZ | Part B Supplier - Clinic/Group Practice | 2860639051 |
Receives reassigned benefits from 1 practitioner Practice locations: Casa Grande, AZ |
National Provider Directory
Locations
204 Galvin Rd N
Bellevue, NE 68005
Phone (402) 639-7648
1314 Galvin Rd S
Bellevue, NE 68005
Phone (720) 341-4162
1100 N Lincoln Ave
Ste D2
York, NE 68467
Phone (402) 256-5867
Interoperability endpoints
- https://api.platform.athenahealth.com/11675/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X | 111265 | NE |
Addresses
Primary practice location
12717 S 28TH Ave
Bellevue, NE 68123-3232
Mailing address
703 Canyon Rd
Bellevue, NE 68005-2735
Phone (402) 525-6976
Other providers in Bellevue, NE
- Bellevue Obstetrics and Gynecology Associates PC
- Bellevue Optical Inc.
- Bellevue Oral and Maxillofacial Surgery
- Bellevue Pediatric Center PC
- Bellevue Physical Therapy, LLC
- Bellevue Public Schools
- Bellevue Urgent Care LP
- Bellevue Vision Clinic, PC
- Bellevue Vol. Fire & Rescue
- Amber Nichole Benak
All providers in Bellevue, NE · Family Medicine Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.