MEDICARE: MS. JENNIFER CHAVEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	1136	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00153597	OTHER	NE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	37833	OTHER	NE	BCBS
5	68154A016	OTHER	NE	TRICARE

General Provider Information

NPI Number	:	1457354789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER CHAVEZ PA-C

Provider Business Mailing Address
First Line	:	PO BOX 3755
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0755
Country	:	US
Telephone Number	:	402-354-2100
Fax Number	:	402-354-2155

Provider Business Practice Location Address
First Line	:	515 N 162ND AVE STE 300
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2540
Country	:	US
Telephone Number	:	402-354-1200
Fax Number	:	402-354-1205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/21/2025

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Directions to “ MS. JENNIFER CHAVEZ PA-C” Practice Location

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