Individual provider Active NPI

Amanda M Votruba, M.D.

  • Pediatrics Physician
  • Elkhorn, NE
National Provider Identifier
1497866883
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
23143 Issued in NE
Practice address
717 N 190TH PLZ
Ste. 3100
Elkhorn, NE 68022-3913
Phone
(402) 815-1325
Fax
(402) 815-1965
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 23143 NE Primary

Addresses

Primary practice location

717 N 190TH PLZ
Ste. 3100
Elkhorn, NE 68022-3913

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
1497866883MedicaidIA
10025837400MedicaidNE
47068731742MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150416002051 NE Practitioner - Pediatric Medicine 4082932363 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Pediatrics CurrentSince Apr 1, 2015 Accepting new patients
Nebraska Methodist Hospital Past Accepting new patients

Locations

717 N 190th Plz
Ste 3100
Elkhorn, NE 68022
Phone (402) 815-1325

717 N 190th Plz
Ste 1300
Elkhorn, NE 68022
Phone (402) 815-1700

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

Interoperability endpoints

  • Direct secure messaging: amanda.votruba@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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1497866883",
    "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": "717 N 190TH PLZ",
            "address_2": "STE. 3100",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223913",
            "telephone_number": "402-815-1325",
            "fax_number": "402-815-1965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOTRUBA",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "23143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497866883",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025837400",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731742",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhorn, NE

Sources for this page

Verify at the official NPI Registry.