MALLORY LEIGH POTTEBAUM (NPI# 1487950945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487950945 |
| Entity Type | Individual |
| Full Name | MALLORY LEIGH POTTEBAUM |
| Other Name | MALLORY LEIGH JOHNSON |
| Credential | PA-C |
| Practice Address |
505 S. 45th St Omaha NE 68198-0001 |
| Mailing Address |
988102 Nebraska Medical Ctr Omaha NE 68198-8102 |
| Practice Telephone | 4025595600 |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2019-06-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1997 | NE | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
505 S. 45TH ST |
| City | OMAHA |
| State | NE |
| Zip Code | 68198-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255381158 | James H Sorrell | Psychiatry & Neurology | 505 S. 45th St, Omaha, NE 68198-5575 | 2006-05-11 |
| 1437763109 | Victoria Q Tran | Nurse Practitioner | 505 S. 45th St, Omaha, NE 68198-0001 | 2020-09-01 |
| 1548817240 | Rachael A Sudtelgte | Nurse Practitioner | 505 S. 45th St, Omaha, NE 68198-0001 | 2019-08-19 |
| 1912565102 | Patricia E Scott | Nurse Practitioner | 505 S. 45th St, Omaha, NE 68198-0001 | 2019-06-03 |
| 1114480845 | Jasmin N Van Weelden | Physician Assistant | 505 S. 45th St, Omaha, NE 68198-0001 | 2019-04-10 |
| 1790176360 | Brittany Mccoy | Physician Assistant | 505 S. 45th St, Omaha, NE 68198-0001 | 2015-02-18 |
| 1528466745 | Lisa Keedy | Nurse Practitioner | 505 S. 45th St, Omaha, NE 68198-0001 | 2014-12-22 |
| 1043622764 | Michael Baine | Radiology | 505 S. 45th St, Omaha, NE 68198-1045 | 2014-05-29 |
| 1275977654 | Jessica Barbara Shank | Surgery | 505 S. 45th St, Omaha, NE 68198-0001 | 2013-04-29 |
| 1720321342 | Elizabeth Bradford Bell | Otolaryngology | 505 S. 45th St, Omaha, NE 68198-0001 | 2013-04-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881259646 | Grant Saltzgaber | Family Medicine | Unmc Dept. of Family Medicine, 983075 Nebraska Medical Center, Omaha, NE 68198 | 2019-05-07 |
| 1215590468 | Elizabeth Farrell | Counselor | 42nd @ Dewey, Omaha, NE 68198 | 2019-04-15 |
| 1073033981 | Daniel Ryan Mcdonald | Anesthesiology | 984150 Nebraska Medical Center, Omaha, NE 68198 | 2017-06-21 |
| 1194258764 | Bryan Baker | Student in an Organized Health Care Education/Training Program | 986155 Nebraska Medical Ctr, Omaha, NE 68198 | 2017-04-10 |
| 1063862779 | Evin Lackore | Pediatrics | Unmc Pediatrics Residency Program, 982185 Nebraska Medical Center, Omaha, NE 68198 | 2016-06-14 |
| 1710361233 | Rahul Dhawan | Student in an Organized Health Care Education/Training Program | 982265 Nebraska Medical Center, Omaha, NE 68198 | 2015-07-14 |
| 1295129757 | Brandon Mark Bennett | Student in an Organized Health Care Education/Training Program | 985640 Nebraska Medical Ctr, Omaha, NE 68198 | 2015-03-23 |
| 1083029151 | Ashley Nelson | Pediatrics | 982185 Nebraska Medical Center, Omaha, NE 68198 | 2014-06-26 |
| 1013205590 | Urmila Mukherjee | Internal Medicine | 989500 Nebraska Medical Ctr, Omaha, NE 68198 | 2011-07-18 |
| 1184943037 | Melissa Teply | Internal Medicine | 989500 Nebraska Medical Center, Omaha, NE 68198 | 2010-05-18 |
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| 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.