Active NPI
Elite Professionals Home Care LLC
- Home Health Agency
- Fremont, NE
National Provider Identifier
1518478403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- ELITE PROFESSIONALS HOME CARE LLC
- Practice address
- 2127 E 23Rd Ave S
Fremont, NE 68025-2465 - Phone
- (402) 704-2031
- Fax
- (402) 704-2032
- NPI assigned
- Oct 18, 2017
- Last updated
- Oct 18, 2017
- Organization subpart
- Yes
- Parent organization
- ELITE PROFESSIONALS HOME CARE LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer K Gibbons
- Title
- President
- Phone
- (402) 464-2422
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NE | Primary |
Addresses
Primary practice location
2127 E 23Rd Ave S
Fremont, NE 68025-2465
Mailing address
3901 Faulkner Dr
Lincoln, NE 68516-4738
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025122700 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030724000021 | NE | Part A Provider - Home Health Agency | 1759292568 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lincoln, NE; Omaha, NE |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1518478403. Details of each certification follow.
Home health agency certification: CCN 287122
- Legal name
- ELITE PROFESSIONALS HOME CARE LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 20, 2004
- Last certification
- Feb 11, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Enrollment address
- 3901 Faulkner Dr
Lincoln, NE 68516-4738
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Elite Professionals Home Care Company
- Overall star rating
- Ownership
- Proprietary
- Certified
- May 20, 2004
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Part of
- Elite Professionals Home Care LLC
Locations
218 E 4th St
Ste 5
Fremont, NE 68025
Phone (402) 416-2208
125 N Washington St
Papillion, NE 68046
Phone (402) 339-7727
1410 E Gold Coast Rd
Ste 400
Papillion, NE 68046
Phone (402) 884-1429
Ownership & related parties
All disclosed owners & managing parties 13
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Cheryl Abel | Corporate Officer | Oct 1, 2016 | |
| Jennifer K Gibbons | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 20.4% |
| Corporate Officer | Jul 1, 2003 | ||
| Corporate Director | Jul 1, 2003 | ||
| W-2 Managing Employee | Jul 1, 2003 | ||
| Operational/Managerial Control | Jul 1, 2003 | ||
| Curis Partners LLC | Operational/Managerial Control | Aug 13, 2021 | 100% |
| Derek Gibbons | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 19.6% |
| Stephanie D Wiese | W-2 Managing Employee | Jun 1, 2010 | |
| Operational/Managerial Control | Jun 1, 2010 | ||
| Zafar Azimov | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 6% |
| Zamwell Group LLC | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 6% |
| Apex Home Health Nebraska LLC | 5% Or Greater Direct Ownership Interest | Oct 1, 2016 | 60% |
| James G Adamson | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 6% |
| Anna J Haynes | Operational/Managerial Control | Aug 13, 2021 | 10% |
| Gibbons Home Care Inc | 5% Or Greater Direct Ownership Interest | Oct 1, 2016 | 40% |
| Apex Home Health LLC | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 28.8% |
| Healthcare Partners 2016 Fund LLC | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 12% |
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Occupational Therapist
- Omaha, NE
- NPI 1578171963
-
- Nurse's Aide
- Omaha, NE
- NPI 1467251009
-
- Nurse's Aide
- Omaha, NE
- NPI 1194520262
-
- Physical Therapy Assistant
- Omaha, NE
- NPI 1336803477
-
- Nurse's Aide
- Omaha, NE
- NPI 1114722345
Affiliated clinicians 18
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Omaha, NE
- NPI 1740803899
Home health agency
-
- Family Nurse Practitioner
- Lincoln, NE
- NPI 1558856898
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1508284800000",
"number": "1518478403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3901 FAULKNER DR",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685164738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2127 E 23RD AVE S",
"city": "FREMONT",
"state": "NE",
"postal_code": "680252465",
"telephone_number": "402-704-2031",
"fax_number": "402-704-2032"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELITE PROFESSIONALS HOME CARE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ELITE PROFESSIONALS HOME CARE LLC",
"enumeration_date": "2017-10-18",
"last_updated": "2017-10-18",
"status": "A",
"authorized_official_last_name": "GIBBONS",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "402-464-2422"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025122700",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.