Individual provider Active NPI

Carly Jo Moran

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1902530058
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3049 Issued in NE
Practice address
42ND and Emile
Omaha, NE 68198-0001
Phone
(402) 559-4000
NPI assigned
Jul 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3049 NE Primary

Addresses

Primary practice location

42ND and Emile
Omaha, NE 68198-0001

Mailing address

1337 W Whitechurch LN
Sioux Falls, SD 57108-3322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240301001108 NE Practitioner - Physician Assistant 2769827658 Reassigns benefits to 2 organizations
I20241119002447 IA Practitioner - Physician Assistant 2769827658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
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
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

16909 Lakeside Hills CT
Omaha, NE 68130-4661

800 Mercy Dr
Council Bluffs, IA 51503-3128

987400 Nebraska Medical Ctr
Unmc Physicians Nebraska Medical Center
Omaha, NE 68198-7400
Phone (402) 559-4000

Emile 42ND St
Omaha, NE 68198-0001
Phone (402) 559-4015

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3049NEMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Nov 19, 2024 Accepting new patients
Alegent Creighton Clinic CurrentSince Nov 19, 2024 Accepting new patients
Alegent Creighton Clinic Physician Assistant CurrentSince Nov 19, 2024 Accepting new patients

Locations

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

2771 Solution Ctr
Chicago, IL 60677

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

4220 L St
Omaha, NE 68107
Phone (402) 717-7050

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

Interoperability endpoints

  • Direct secure messaging: cmoran371390@direct.nebraskamed.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1657756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1902530058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 W WHITECHURCH LN",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571083322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42ND AND EMILE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681980001",
            "telephone_number": "402-559-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "CARLY",
        "middle_name": "JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-14",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "3049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.