Individual provider Active NPI

Fernando E Correa, M.D.

  • Family Medicine Physician
  • Omaha, NE
National Provider Identifier
1790765766
Registry record updated Apr 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18632 Issued in NE
Practice address
4828 S 24TH St
Omaha, NE 68107-2703
Phone
(402) 978-5182
Fax
(402) 341-3616
NPI assigned
Jan 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 18632 NE Primary

Addresses

Primary practice location

4828 S 24TH St
Omaha, NE 68107-2703

Mailing address

4828 S 24TH St
Omaha, NE 68107-2703
Phone (402) 731-9100

Other identifiers 2

IdentifierTypeStateIssuer
2500090MedicaidIA
47080939901MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060220000117 NE Practitioner - Family Practice 1254346851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fernando E Correa MD a Professional CorporationGroup PAC ID 4981843950, 3 clinicians

Practice addresses (Care Compare)

4828 S 24TH St
Omaha, NE 68107-2703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18632NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fernando E Correa, M.D., a Professional Corporation Family Medicine CurrentSince May 1, 1998 Accepting new patients

Locations

4828 S 24th St
Omaha, NE 68107
Phone (402) 731-9100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366761600000",
    "number": "1790765766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4828 S 24TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681072703",
            "telephone_number": "402-731-9100",
            "fax_number": "402-731-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4828 S 24TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681072703",
            "telephone_number": "402-978-5182",
            "fax_number": "402-341-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORREA",
        "first_name": "FERNANDO",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2013-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "18632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2500090",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47080939901",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.