NPIMap

Organization Active NPI

Pace Iowa

  • PACE Provider Organization
  • Council Bluffs, IA
National Provider Identifier
1811207889
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
PACE IOWA
Doing business as
Immanuel Pathways
Practice address
1702 N 16TH St
Council Bluffs, IA 51501-0121
Phone
(712) 256-7284
NPI assigned
Oct 8, 2010
Organization subpart
Yes
Parent organization
IMMANUEL HOME AND COMMUNITY RESOURCESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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

Authorized official

Name
Mr. Andrew J Fisher
Title
VP of Community Operations
Phone
(402) 829-2954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

1702 N 16TH St
Council Bluffs, IA 51501-0121

Mailing address

6757 Newport Ave
Suite 200
Omaha, NE 68152-2262
Phone (402) 829-2900

Other names 1

  • Immanuel Pathways Doing business as

National Provider Directory

National Provider Directory

Locations

1702 N 16th St
Council Bluffs, IA 51501
Phone (712) 256-7223

6757 Newport Ave
Ste 200
Omaha, NE 68152
Phone (402) 829-2900

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1811207889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6757 NEWPORT AVE",
            "address_2": "SUITE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681522262",
            "telephone_number": "402-829-2900",
            "fax_number": "402-829-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 N 16TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515010121",
            "telephone_number": "712-256-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACE IOWA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMMANUEL HOME AND COMMUNITY RESOURCES",
        "enumeration_date": "2010-10-08",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP OF COMMUNITY OPERATIONS",
        "authorized_official_telephone_number": "402-829-2954",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immanuel Pathways",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.