NPIMap

Individual provider Active NPI

Tina M. Recker-Cutshall, PA-C

  • Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1891805115
Registry record updated Feb 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001399 Issued in IA
Practice address
933 E Pierce St
Council Bluffs, IA 51503-4626
Phone
(712) 396-6111
Fax
(712) 396-7026
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 999 NE
Physician Assistant 363A00000X 001399 IA Primary

Addresses

Primary practice location

933 E Pierce St
Council Bluffs, IA 51503-4626

Mailing address

PO Box 2797
Omaha, NE 68103-2797
Phone (402) 354-4230

Other identifiers 2

IdentifierTypeStateIssuer
1891805115MedicaidIA
42068035512MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071220000630 IA Practitioner - Physician Assistant 4183714686 Reassigns benefits to 1 organization
I20100623000993 NE Practitioner - Physician Assistant 4183714686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pgfhgs Holdings LLCGroup PAC ID 9537695481, 12 clinicians

Practice addresses (Care Compare)

3506 S 201St Cir
Omaha, NE 68130-5094
Phone (402) 681-4030

933 E Pierce St
Council Bluffs, IA 51503-4626
Phone (712) 396-6111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
999NEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jennie Edmundson Memorial Hospital Physician Assistant CurrentSince Feb 12, 2018 Accepting new patients
New Century Physicians of Nebraska LLC CurrentSince Sep 5, 2020 Accepting new patients
Children's Physicians Past Accepting new patients
Millard Premier Medicine and Aesthetics, L.P. PastSince Aug 7, 2023 Accepting new patients
Muc-Papillion LLC Past Accepting new patients

Locations

1 Edmundson Pl
Ste 310
Council Bluffs, IA 51503
Phone (712) 328-1801

1 Edmundson Pl
Ste 100
Council Bluffs, IA 51503
Phone (712) 396-4429

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

1 Edmundson Pl
Council Bluffs, IA 51503
Phone (712) 396-4000

8601 W Dodge Rd
Ste 216
Omaha, NE 68114
Phone (402) 354-4822

16901 Lakeside Hills Ct
Omaha, NE 68130
Phone (402) 572-6500

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518134400000",
    "number": "1891805115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2797",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681032797",
            "telephone_number": "402-354-4230",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E PIERCE ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034626",
            "telephone_number": "712-396-6111",
            "fax_number": "712-396-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECKER-CUTSHALL",
        "first_name": "TINA",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2018-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "999",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891805115",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42068035512",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.