NPIMap

Individual provider Active NPI

Paul Anthony Jackman, APRN

  • Acute Care Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1902289820
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
111818 Issued in NE
Practice address
7500 Mercy Rd
Omaha, NE 68124-2319
Phone
(402) 398-5580
Fax
(402) 398-5589
NPI assigned
Jul 9, 2015
Last updated
Jul 9, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 111818 NE Primary
Adult Health Nurse Practitioner 363LA2200X 111818 NE
Gerontology Nurse Practitioner 363LG0600X 111818 NE

Addresses

Primary practice location

7500 Mercy Rd
Omaha, NE 68124-2319

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (402) 398-5580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 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
I20150729007071 NE Practitioner - Nurse Practitioner 2961716428 Reassigns benefits to 2 organizations
I20160204001415 IA Practitioner - Nurse Practitioner 2961716428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Creighton University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, shared by 2 NPIs, 951 clinicians

Practice addresses (Care Compare)

16901 Lakeside Hills CT
Omaha, NE 68130-2318
Phone (855) 524-4001

800 Mercy Dr
Suite 220
Council Bluffs, IA 51503-3128
Phone (712) 388-2660

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
111818NEMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
CHI Health Clinic Specialty, LLC CurrentSince Jan 1, 2021 Accepting new patients
Alegent Creighton Clinic CurrentSince Dec 31, 2015 Accepting new patients
Alegent Creighton Clinic CurrentSince Jul 28, 2015 Accepting new patients
Alegent Creighton Clinic Current Accepting new patients

Locations

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

2771 Solution Ctr
Chicago, IL 60677

555 S 70th St
Lincoln, NE 68510
Phone (402) 219-8000

8207 Northwoods Dr
Ste 100
Lincoln, NE 68505
Phone (402) 484-3440

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

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

7500 Mercy Rd
Omaha, NE 68124
Phone (402) 398-5880

Organizations & group practices 4

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 6

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": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436400000000",
    "number": "1902289820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "402-398-5580",
            "fax_number": "402-398-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242319",
            "telephone_number": "402-398-5580",
            "fax_number": "402-398-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "PAUL",
        "middle_name": "ANTHONY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-09",
        "last_updated": "2015-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NE",
            "license": "111818",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NE",
            "license": "111818",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NE",
            "license": "111818",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.