STACEY M SAMUEL (NPI# 1417507260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417507260 |
| Entity Type | Individual |
| Full Name | STACEY M SAMUEL |
| Credential | PA-C |
| Practice Address |
6901 N 72nd St Omaha NE 68122-1709 |
| Practice Telephone | 8555244001 |
| Practice Fax Number | 4025723206 |
| Mailing Telephone | 8555244001 |
| Mailing Fax Number | 4025723206 |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2019-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 098001 | IA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | 2396 | NE | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6901 N 72ND ST |
| City | OMAHA |
| State | NE |
| Zip Code | 68122-1709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386641686 | Paul L. Price | Pharmacist | 6901 N 72nd St, Omaha, NE 68122-1709 | 2005-06-30 |
| 1205436896 | Jennifer S Bostick | Counselor | 6901 N 72nd St, Omaha, NE 68122-1709 | 2020-11-01 |
| 1861028847 | Ryan Pirraglia | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2020-03-21 |
| 1861041238 | Jonathan Robbins | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2019-09-09 |
| 1114408531 | Nicole M Anthony | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2018-08-23 |
| 1144746322 | Nicole M Privitera | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2017-08-18 |
| 1588196299 | Felina Brown | Nurse Practitioner | 6901 N 72nd St, Attn: Hospital Medicine Dept., Omaha, NE 68122-1709 | 2017-03-31 |
| 1851846380 | Jacqueline Jaramillo | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2016-08-25 |
| 1942755954 | Date Amouzou | Nurse Practitioner | 6901 N 72nd St, Omaha, NE 68122-1709 | 2016-08-19 |
| 1477008571 | Rabie Emsalem | Internal Medicine | 6901 N 72nd St, Omaha, NE 68122 | 2016-08-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609282920 | Andre Jordan | Registered Nurse | 7215 N. 90th Street, Omaha, NE 68122 | 2014-07-08 |
| 1063748895 | Amy Kristine Jones | Speech-Language Pathologist | 703 Country View Dr, Champaign, IL 68122 | 2009-10-29 |
| 1992964100 | Alegent Health Immanuel Medical Center | Psychiatric Residential Treatment Facility | 6845 N 68th Plaza, Omaha, NE 68122 | 2008-06-03 |
| 1093835852 | Suzane Lynne Bohlen | Nurse Anesthetist, Certified Registered | 6901 N 72 St, Omaha, NE 68122 | 2007-03-29 |
| 1376686733 | Midwest Surgical Associates PC | Surgery | 6828 N 72 St, #5500, Omaha, NE 68122 | 2007-02-15 |
| 1902975386 | Midwest Medical Imaging Center Inc | Radiology | Midwest Medical Imaging Center, 6901 North 72nd Street, Omaha, NE 68122 | 2006-11-07 |
| 1245348754 | Scott Denman Wilt | Anesthesiology | 6901 N 72 Street, Omaha, NE 68122 | 2006-08-25 |
| 1982620639 | Robert J Zadalis | Surgery | 6829 N 72nd St Ste 5500, Omaha, NE 68122 | 2006-07-14 |
| 1245299304 | Kristin Nicole Krobot | Physician Assistant | 6901 N. 72nd St., Immanuel Emergency Room, Omaha, NE 68122 | 2006-03-18 |
| 1326575440 | Kathleen L Koeppel | Registered Nurse | 6901 N 72nd Street, Attn: Diabetic Education, Omaha, NE 68122 | 2017-05-19 |
| Find all providers in zip 68122 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475375 | Patrick Donald Heavey | Physician Assistant | 4660 Pine St, Omaha, NE 68106-2520 | 2020-10-22 |
| 1780297440 | Tayler Marie Llewellyn | Physician Assistant | 17241 Oak Dr, Omaha, NE 68130-2428 | 2020-08-24 |
| 1154933992 | Alexandria Rae Mctaggart | Physician Assistant | 5024 S 130th St, Omaha, NE 68137-1820 | 2020-08-22 |
| 1124651443 | Kathryn A Kesti | Physician Assistant | 4242 Farnam St Ste 500, Omaha, NE 68131-2850 | 2020-02-14 |
| 1760014757 | Timothy Shew | Physician Assistant | 7500 Mercy Rd Ste 1300, Omaha, NE 68124-2319 | 2020-02-07 |
| 1083264303 | Alicia K Clough | Physician Assistant | 15236 Westchester Dr, Omaha, NE 68154-2060 | 2019-09-18 |
| 1669935565 | Taylor Elizabeth Hepp | Physician Assistant | 8005 Farnam Dr Ste 204, Omaha, NE 68114-3426 | 2019-04-09 |
| 1851895924 | Mohammed Saeb Shakir | Physician Assistant | 7306 Ontario St, Omaha, NE 68124-3561 | 2018-03-22 |
| 1386162790 | Anna Jean Sorrell | Physician Assistant | Emile St & S 42nd St, Omaha, NE 68198-4742 | 2017-09-06 |
| 1659804292 | Kaitlyn Ann Boosalis | Physician Assistant | 4331 Mayberry St, Omaha, NE 68105-1711 | 2017-04-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.