Individual provider Active NPI

Rebecca Ruth Ellsworth, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1902950884
Registry record updated Mar 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1262 Issued in NE
Practice address
20310 Blue Sage Pkwy
Omaha, NE 68130-3746
Phone
(402) 559-0111
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2020

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 1262 NE Primary

Addresses

Primary practice location

20310 Blue Sage Pkwy
Omaha, NE 68130-3746

Mailing address

988102 Nebraska Medical Ctr
Omaha, NE 68198-8102

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070508000705 NE Practitioner - Physician Assistant 1456457456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

20310 Blue Sage Pkwy
Omaha, NE 68130-3746
Phone (402) 559-0111

2510 Bellevue Medical Ctr Dr
Bellevue, NE 68123-1520

5005 Ames Ave
Omaha, NE 68104-2323
Phone (402) 559-0282

8343 S 168TH Ave
Unmc Physicians Chalco
Omaha, NE 68136-1677
Phone (402) 559-0444

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
1262NEMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Nebraska Medical Center PastSince Mar 9, 2020 Accepting new patients

Organizations & group practices 2

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 2

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583020800000",
    "number": "1902950884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "988102 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681988102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20310 BLUE SAGE PKWY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681303746",
            "telephone_number": "402-559-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "REBECCA",
        "middle_name": "RUTH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-03-01",
        "certification_date": "2020-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.