NPIMap

Individual provider Active NPI

Donald Paul Scarborough, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1720186109
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2071 Issued in NE
Practice address
11810 Nicholas St
Omaha, NE 68154-4449
Phone
(402) 401-4404
Fax
(402) 999-7698
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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 001018 IA
Physician Assistant 363A00000X 2071 NE Primary

Addresses

Primary practice location

11810 Nicholas St
Omaha, NE 68154-4449

Mailing address

105 South 90TH St. Suite 201
Omaha, NE 68114
Phone (402) 779-8400

Other identifiers 1

IdentifierTypeStateIssuer
47068731777MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050420000508 IA Practitioner - Physician Assistant 1850339805 Reassigns benefits to 3 organizations
I20161228000385 NE Practitioner - Physician Assistant 1850339805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Montgomery County Memorial HospitalGroup PAC ID 9032015805, shared by 7 NPIs, 43 clinicians

Practice addresses (Care Compare)

2301 Eastern Ave
Red Oak, IA 51566-1300
Phone (712) 623-7000

Hospital & facility affiliations

  • Angels Care Home Health of Iowa Home health agency, Council Bluffs, IA, CCN 167292
  • Montgomery County Memorial Hospital Hospital, Red Oak, IA, CCN 161363
  • Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2071NEMDMental Health Counselor
001018IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery County Memorial Hospital Current Accepting new patients
Montgomery County Memorial Hospital CurrentSince Sep 21, 2024 Accepting new patients
Novis Health PC Physician Assistant CurrentSince Jan 31, 2021 Accepting new patients
Montgomery County Memorial Hospital Physician Assistant CurrentSince Sep 21, 2024 Accepting new patients
Jennie Edmundson Memorial Hospital Physician Assistant Past Accepting new patients
Bott PC Past Accepting new patients

Locations

1400 Senate Ave
Red Oak, IA 51566
Phone (712) 623-7250

2301 Eastern Ave
Red Oak, IA 51566
Phone (712) 623-7270

1400 Senate Ave
Ste 103
Red Oak, IA 51566
Phone (712) 623-7240

1400 Senate Ave
Ste 105
Red Oak, IA 51566
Phone (712) 623-7250

1400 Senate Ave
Ste 108
Red Oak, IA 51566
Phone (712) 623-7250

11810 Nicholas St
Ste 100
Omaha, NE 68154
Phone (402) 779-8400

11810 Nicholas St
Omaha, NE 68154
Phone (402) 307-5510

Organizations & group practices 8

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 3

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1720186109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SOUTH 90TH ST. SUITE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68114",
            "telephone_number": "402-779-8400",
            "fax_number": "402-779-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11810 NICHOLAS ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681544449",
            "telephone_number": "402-401-4404",
            "fax_number": "402-999-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCARBOROUGH",
        "first_name": "DONALD",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001018",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731777",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.