Individual provider Active NPI

Stephanie Ann Lafountain, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1538588736
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1816 Issued in NE
Practice address
8303 Dodge St
Omaha, NE 68114-4108
Phone
(402) 354-2360
Fax
(402) 354-2440
NPI assigned
Apr 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1816 NE Primary

Addresses

Primary practice location

8303 Dodge St
Omaha, NE 68114-4108

Mailing address

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

Other practice location 1

222 N 192nd St
Elkhorn, NE 68022-5363
Phone (402) 390-4111

Other identifiers 3

IdentifierTypeStateIssuer
470376604-12MedicaidNE
470687317-16MedicaidNE
1538588736MedicaidIA

Other names 1

  • Stephanie Ann Brady Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140703002036 NE Practitioner - Physician Assistant 2062637184 Reassigns benefits to 2 organizations
I20230512000968 IA Practitioner - Physician Assistant 2062637184 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2013
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)

10060 Regency Cir
Omaha, NE 68114-3732
Phone (402) 354-1570

8303 Dodge St
Omaha, NE 68114-4108
Phone (402) 354-8163

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1816NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nebraska Methodist Hospital Physician Assistant CurrentSince Nov 14, 2016 Accepting new patients
Physicians Clinic Inc Physician Assistant CurrentSince Nov 14, 2016 Accepting new patients

Locations

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

2959 US Highway 275
Hamburg, IA 51640
Phone 71238215158070

222 N 192nd St
Elkhorn, NE 68022

2540 N Healthy Way
Fremont, NE 68025
Phone (402) 721-3133

450 E 23rd St
Fremont, NE 68025
Phone (402) 721-1610

6901 N 72nd St
Omaha, NE 68122
Phone (402) 572-2121

8303 Dodge St
Ste LL6
Omaha, NE 68114
Phone (402) 354-4104

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

8005 Farnam Dr
Ste 305
Omaha, NE 68114

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

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

8303 W Dodge Rd
Omaha, NE 68114
Phone (402) 354-4000

Organizations & group practices 3

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 1

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": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1538588736",
    "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": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 DODGE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144108",
            "telephone_number": "402-354-2360",
            "fax_number": "402-354-2440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 N 192nd St",
            "address_purpose": "LOCATION",
            "city": "Elkhorn",
            "state": "NE",
            "postal_code": "680225363",
            "country_code": "US",
            "telephone_number": "402-390-4111",
            "fax_number": "402-390-4115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAFOUNTAIN",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470376604-12",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470687317-16",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538588736",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "BRADY",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.