NPIMap

Organization Active NPI

Alegent Creighton Health

  • Community/Retail Pharmacy
  • Omaha, NE
National Provider Identifier
1760578652
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2288 Issued in NE
Legal business name
ALEGENT CREIGHTON HEALTH
Practice address
16909 Lakeside Hills CT Ste 107
Omaha, NE 68130-4661
Phone
(402) 758-5006
Fax
(402) 758-5094
NPI assigned
Oct 5, 2006
Last updated
Oct 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Authorized official

Name
Mike Tiesi
Title
Senior Director of Pharmacy
Phone
(402) 343-4546

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 2288 NE Primary

Addresses

Primary practice location

16909 Lakeside Hills CT Ste 107
Omaha, NE 68130-4661

Mailing address

16909 Lakeside Hills CT Ste 107
Omaha, NE 68130-4661
Phone (402) 758-5006

Other identifiers 2

IdentifierTypeStateIssuer
10026519109MedicaidNE
2661OtherNENEBRASKA COMMUNITY PHARMACY PERMIT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160202001309 NE Part B Supplier - Mass Immunization (Roster Biller Only) 1850285255 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Omaha, NE; Papillion, NE; Lincoln, NE; Lavista, NE; Grand Island, NE; Elkhorn, NE; Bellevue, NE
O20161122002233 NE DME Supplier - Pharmacy 1850285255 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Omaha, NE

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

Member of 6

Organizations this organization is a member of, according to the National Provider Directory.

Locations

16909 Lakeside Hills Ct
Ste 107
Omaha, NE 68130
Phone (402) 758-5006

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1760578652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16909 LAKESIDE HILLS CT STE 107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304661",
            "telephone_number": "402-758-5006",
            "fax_number": "402-758-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16909 LAKESIDE HILLS CT STE 107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304661",
            "telephone_number": "402-758-5006",
            "fax_number": "402-758-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT CREIGHTON HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "TIESI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "402-343-4546"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "2288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026519109",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA COMMUNITY PHARMACY PERMIT",
            "identifier": "2661",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.