NPIMap

Organization Active NPI

Bellevue Primary Healthcare PC

  • Family Medicine Physician
  • Bellevue, NE
National Provider Identifier
1497091888
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Apr 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Authorized official

Name
Mrs. Kelli Rae Pavlish, APRNNPI 1255611059
Title
Nurse Practitioner
Phone
(402) 525-6976

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

1314 Galvin Rd S
Bellevue, NE 68005
Phone (720) 341-4162

1320 Galvin Rd S
Bellevue, NE 68005
Phone (402) 603-0839

10685 Bedford Ave
Omaha, NE 68134
Phone (402) 898-4768

1100 N Lincoln Ave
Ste D2
York, NE 68467
Phone (402) 256-5867

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11675/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1497091888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 CANYON RD",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680052735",
            "telephone_number": "402-525-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12717 S 28TH AVE",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681233232",
            "telephone_number": "402-525-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE PRIMARY HEALTHCARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-12",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "PAVLISH",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "402-525-6976",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NE",
            "license": "111265",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.