Individual provider Active NPI

Shiva Pavan Ponamgi, M.D.

  • Cardiovascular Disease Physician
  • Omaha, NE
National Provider Identifier
1669743118
Registry record updated Jul 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
36422 Issued in NE
Practice address
7500 Mercy Rd
Omaha, NE 68124-2319
Phone
(402) 398-5880
NPI assigned
Jan 14, 2012
Last updated
Jul 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57047 MN
Cardiovascular Disease Physician 207RC0000X 36422 NE Primary
Hospitalist Physician 208M00000X 57047 MN
Student in an Organized Health Care Education/Training Program 390200000X PERMIT ONLY NJ

Addresses

Primary practice location

7500 Mercy Rd
Omaha, NE 68124-2319

Mailing address

7500 Mercy Rd
Omaha, NE 68124-2319
Phone (402) 398-5880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240903003804 IA Practitioner - Interventional Cardiology 7517109390 Reassigns benefits to 1 organization
I20240920000188 NE Practitioner - Interventional Cardiology 7517109390 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHI Health Clinic Specialty LLCGroup PAC ID 4789098443, 317 clinicians
Alegent Creighton ClinicGroup PAC ID 1951210418, shared by 2 NPIs, 951 clinicians

Practice addresses (Care Compare)

555 S 70TH St
St Elizabeth Regional Med Center
Lincoln, NE 68510-2462
Phone (402) 219-8000

7500 Mercy Rd
Omaha, NE 68124-2319
Phone (402) 398-5580

800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone (712) 328-5490

8207 Northwoods Dr
Suite 100
Lincoln, NE 68505-2093
Phone (402) 484-3440

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting31
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57047MNMDInternal Medicine Physician
36422NEMDCardiovascular Disease Physician
PERMIT ONLYNJMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
CHI Health Clinic Specialty, LLC Hospitalist CurrentSince Feb 3, 2025 Accepting new patients
Alegent Creighton Clinic CurrentSince Aug 20, 2024 Accepting new patients
Alegent Creighton Clinic Internal Medicine CurrentSince Aug 20, 2024 Accepting new patients

Locations

800 Mercy Dr
Council Bluffs, IA 51503
Phone (712) 328-5000

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

2771 Solution Ctr
Chicago, IL 60677

3308 Samson Way
Bellevue, NE 68123
Phone (402) 291-3373

7440 S 91st St
Lincoln, NE 68526
Phone (402) 489-6554

8207 Northwoods Dr
Ste 100
Lincoln, NE 68505
Phone (402) 484-3440

7500 Mercy Rd
Omaha, NE 68124
Phone (402) 398-5880

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1326499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720310400000",
    "number": "1669743118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242319",
            "telephone_number": "402-398-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242319",
            "telephone_number": "402-398-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONAMGI",
        "first_name": "SHIVA",
        "middle_name": "PAVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-14",
        "last_updated": "2024-07-07",
        "certification_date": "2024-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "57047",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NE",
            "license": "36422",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "57047",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": "PERMIT ONLY",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.