NPIMap

Organization Active NPI

Nebraska Medical Center

  • Pharmacy
  • Omaha, NE
National Provider Identifier
1780135319
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
3114 Issued in NE
Legal business name
NEBRASKA MEDICAL CENTER
Practice address
4014 Leavenworth Street
Omaha, NE 68198-5610
Phone
(402) 552-7999
Fax
(402) 552-7792
NPI assigned
Oct 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
April M. Davidson, RPH
Title
Pharmacy Manager
Phone
(402) 559-3287

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 3114 NE Primary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4014 Leavenworth Street
Omaha, NE 68198-5610

Mailing address

4014 Leavenworth Street
Omaha, NE 68105
Phone (402) 552-3927

Other identifiers 2

IdentifierTypeStateIssuer
3114OtherNENEBRASKA PHARMACY PERMIT
2165727OtherPK

Other names 1

  • Neb. Medicine Pharmacy at Lauritzen Outpatient Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210120002110 NE DME Supplier - PharmacyDME Supplier - Hospital 4284544461 Practice locations: Omaha, NE

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Nebraska Medicine Pharmacy at Lauri4014 Leavenworth Street, Omaha, NE 68198-5610(402) 552-7999 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jan 1, 1997

National Provider Directory

National Provider Directory
Tax ID family
Clarkson Primary Care16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Member of 2

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

Locations

4014 Leavenworth St
Omaha, NE 68198

Ownership & related parties

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
The Nebraska Medical CenterOmaha, NE, CCN 280013 Hospital Operational/Managerial Control Oct 1, 1997
Community Hospital AssociationFairfax, MO, CCN 261303 Hospital Operational/Managerial Control Oct 13, 2008
Community Hospital AssociationFairfax, MO, CCN 26Z303 Hospital Operational/Managerial Control Oct 13, 2008
Bellevue Medical Center - Nebraska MedicineBellevue, NE, CCN 280132 Hospital 5% Or Greater Direct Ownership Interest (100%)
Limited Partnership Interest (100%)		 Jul 1, 2015
Nov 6, 2009
South Holt Family MedicineOregon, MO, CCN 268753 Rural health clinic Operational/Managerial Control Jan 5, 2016
Mound City Family MedicineMound City, MO, CCN 268755 Rural health clinic Operational/Managerial Control Jan 5, 2016
Tarkio Family MedicineTarkio, MO, CCN 268771 Rural health clinic Operational/Managerial Control Jul 1, 2017
Fairfax Family MedicineFairfax, MO, CCN 268770 Rural health clinic Operational/Managerial Control Oct 3, 2018
Rock Port Family MedicineRock Port, MO, CCN 268779 Rural health clinic Operational/Managerial Control Jul 1, 2017

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1780135319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 LEAVENWORTH STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68105",
            "telephone_number": "402-552-3927",
            "fax_number": "402-559-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 LEAVENWORTH STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681985610",
            "telephone_number": "402-552-7999",
            "fax_number": "402-552-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEBRASKA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "402-559-3287",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NE",
            "license": "3114",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA PHARMACY PERMIT",
            "identifier": "3114",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2165727",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neb. Medicine Pharmacy at Lauritzen Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.