Individual provider Active NPI

Shelby E Neuroth, PAC

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1659031078
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2714 Issued in NE
Practice address
2725 S 144TH St Ste 212
Omaha, NE 68144-5253
Phone
(402) 609-3000
NPI assigned
Dec 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 119989 IA
Physician Assistant 363A00000X 2714 NE Primary

Addresses

Primary practice location

2725 S 144TH St Ste 212
Omaha, NE 68144-5253

Mailing address

7727 N 88TH St
Omaha, NE 68122-5268

Other names 1

  • Shelby E Van Den Berg 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
I20220409000092 NE Practitioner - Physician Assistant 7214323799 Reassigns benefits to 1 organization
I20230804000925 IA Practitioner - Physician Assistant 7214323799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthowest, LLCGroup PAC ID 8921086893, 109 clinicians

Practice addresses (Care Compare)

1260 Valley View Dr
Council Bluffs, IA 51503-5245
Phone (402) 609-3000

2725 S 144TH St
Omaha, NE 68144-5253
Phone (402) 609-3000

3415 S 205TH St
Orthonebraska Clinics
Omaha, NE 68022-3509
Phone (402) 609-3000

3415 S 205TH St RM
B100 Nebraska Orthopaedic Hospital
Elkhorn, NE 68022-3509
Phone (402) 609-3000

933 E Pierce St
Jennie Edmundson Memorial Hospital
Council Bluffs, IA 51503-4626
Phone (712) 396-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2714NEMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthowest LLC Physician Assistant CurrentSince Jul 3, 2023 Accepting new patients
Orthowest LLC Physician Assistant CurrentSince Jul 3, 2023 Accepting new patients

Locations

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

2725 S 144th St
Ste 212
Omaha, NE 68144
Phone (402) 354-4000

17701 Manderson St
Omaha, NE 68116

2725 S 144th St
Ste 110
Omaha, NE 68144
Phone (402) 637-0400

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.

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": "1640563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1659031078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7727 N 88TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681225268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 S 144TH ST STE 212",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445253",
            "telephone_number": "402-609-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEUROTH",
        "first_name": "SHELBY",
        "middle_name": "E",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-27",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "119989",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "VAN DEN BERG",
            "middle_name": "E",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.