NPIMap

Organization Active NPI

Alegent Creighton Health

Doing business as CHI Health Psychiatric Associates

  • Psychiatry Physician
  • Council Bluffs, IA
National Provider Identifier
1770922437
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ALEGENT CREIGHTON HEALTH
Doing business as
CHI Health Psychiatric Associates
Practice address
800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone
(712) 328-2609
Fax
(712) 328-9257
NPI assigned
Jun 17, 2013
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CHI NEBRASKAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Keith Jankuski
Title
Coo
Phone
(402) 343-4409

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X
Clinical Neuropsychologist 103G00000X
Psychologist 103T00000X
Clinical Social Worker 1041C0700X
Registered Nurse 163W00000X
Psychiatry Physician 2084P0800X Primary
Nurse Practitioner 363L00000X
Clinical Nurse Specialist 364S00000X

Addresses

Primary practice location

800 Mercy Dr
Council Bluffs, IA 51503-3128

Mailing address

12809 W Dodge Road
Omaha, NE 68154-2155
Phone (402) 398-6255

Other practice location 1

12809 W Dodge Road
Omaha, NE 68154-2155
Phone (402) 398-6255

Other names 1

  • CHI Health Psychiatric Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131023000316 IA Part B Supplier - Clinic/Group Practice 1850285255 Receives reassigned benefits from 51 practitioners
Practice locations: Council Bluffs, IA; Missouri Valley, IA

National Provider Directory

National Provider Directory
Tax ID family
Alegent Health32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Member of 6

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

Member organizations 33

Organizations listed as members of this organization in the National Provider Directory.

View all 33

Locations

801 Harmony St
Ste 302
Council Bluffs, IA 51503
Phone (712) 328-2609

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Thayer County Health ServicesHebron, NE, CCN 281304 Hospital Operational/Managerial Control Jul 29, 2016
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Other Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Other Apr 1, 2002
Nebraska Spine Hospital LLCOmaha, NE, CCN 280133 Hospital 5% Or Greater Direct Ownership Interest (51%) Apr 5, 2010
Thayer County Health ServicesHebron, NE, CCN 28Z304 Hospital Operational/Managerial Control Jul 29, 2016
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 Rural health clinic Other Apr 1, 2002
Davenport Medical ClinicDavenport, NE, CCN 283436 Rural health clinic Operational/Managerial Control Jul 29, 2016
Hebron Medical ClinicHebron, NE, CCN 283434 Rural health clinic Operational/Managerial Control Jul 29, 2016
Deshler Medical ClinicDeshler, NE, CCN 283446 Rural health clinic Operational/Managerial Control Jul 29, 2016
Bruning Medical ClinicBruning, NE, CCN 283433 Rural health clinic Operational/Managerial Control Jul 29, 2016
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Other Apr 1, 2002
Fort Calhoun ClinicFort Calhoun, NE, CCN 288506 Rural health clinic Other Apr 1, 2002

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1770922437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12809 W DODGE ROAD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542155",
            "telephone_number": "402-398-6255",
            "fax_number": "402-829-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MERCY DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515033128",
            "telephone_number": "712-328-2609",
            "fax_number": "712-328-9257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12809 W Dodge Road",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681542155",
            "country_code": "US",
            "telephone_number": "402-398-6255",
            "fax_number": "402-829-8513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALEGENT CREIGHTON HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHI NEBRASKA",
        "enumeration_date": "2013-06-17",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "JANKUSKI",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "402-343-4409"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.