NPIMap

Individual provider Active NPI

Kevin Gary Loontjer, MPAS PA-C

  • Surgical Physician Assistant
  • Fremont, NE
National Provider Identifier
1710125919
Registry record updated Apr 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1419 Issued in NE
Practice address
2740 N Clarkson St
Fremont, NE 68025-7716
Phone
(402) 721-0090
Fax
(402) 721-9661
NPI assigned
Jan 26, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1419 NE Primary

Addresses

Primary practice location

2740 N Clarkson St
Fremont, NE 68025-7716

Mailing address

2740 N Clarkson St
Fremont, NE 68025-7716
Phone (402) 721-0090

Other identifiers 1

IdentifierTypeStateIssuer
47081915413MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090226000642 NE Practitioner - Physician Assistant 3375609399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

16901 Lakeside Hills CT
Omaha, NE 68130-2318
Phone (855) 524-4001

16909 Lakeside Hills CT
Omaha, NE 68130-4661

6829 N 72ND St
Suite 7500
Omaha, NE 68122-1733
Phone (402) 717-6870

6901 N 72ND St
Omaha, NE 68122-1709

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1419NEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Sep 1, 2012 Accepting new patients
Creighton University Past Accepting new patients
Alegent Creighton Clinic Surgical Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

810 N 22nd St
Blair, NE 68008
Phone (402) 426-1116

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

7710 Mercy Rd
Ste 2000
Omaha, NE 68124
Phone (402) 717-0820

Interoperability endpoints

  • Direct secure messaging: kloontjer45591@achce.catholichealth.net

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 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": "1232928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239148800000",
    "number": "1710125919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 N CLARKSON ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680257716",
            "telephone_number": "402-721-0090",
            "fax_number": "402-721-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 N CLARKSON ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680257716",
            "telephone_number": "402-721-0090",
            "fax_number": "402-721-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOONTJER",
        "first_name": "KEVIN",
        "middle_name": "GARY",
        "credential": "MPAS PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-26",
        "last_updated": "2009-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NE",
            "license": "1419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47081915413",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, NE

Sources for this page

Verify at the official NPI Registry.