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JACK FORMANEK MS, LMHP
NPI 1285791376
Counselor - Mental Health in Council Bluffs, IA

Active since January 02, 2007PECOS Enrolled
307 E VIEW DR, COUNCIL BLUFFS, IA 51503(712) 325-1584(712) 325-0546 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Jack Formanek Ms, Lmhp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK FORMANEK MS, LMHP (NPI 1285791376) is an individual mental health provider in Council Bluffs, Iowa, licensed in Iowa (205) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1285791376
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameJACK FORMANEKCredential: MS, LMHP
Location Address307 E VIEW DRCouncil Bluffs, IA 51503-0464
Mailing Address307 E View DrCouncil Bluffs, IA 51503-0464 · (712) 325-1584 · Fax (712) 325-0546
Phone(712) 325-1584
Fax(712) 325-0546
Sole ProprietorYes
Enumeration DateJanuary 2, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1285791376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in IA · 205
307 E VIEW DR, Council Bluffs, IA 51503
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack Formanek Ms, Lmhp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jack Formanek reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Charles Drew Health Center, Inc
6.9 mi
Federally Qualified Health Center (FQHC)
2915 GRANT STREET
Omaha, NE 68111
  • Reassigned Medicare billing, Nebraska enrollment
  • 65 clinicians in this Medicare group
NPI 1255302170 (402) 451-3553

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Formanek's NPI number?

The NPI number for Jack Formanek is 1285791376. It was assigned to this individual provider in the NPPES registry on January 2, 2007.

Where is Jack Formanek located?

Jack Formanek practices at 307 E View Dr, Council Bluffs, IA 51503. The listed phone number is (712) 325-1584.

What is Jack Formanek's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jack Formanek enrolled in Medicare?

Yes. Jack Formanek is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Formanek's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Formanek reassigns Medicare benefits to Charles Drew Health Center, Inc (Omaha, NE). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Formanek's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Formanek accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Blue Cross and Blue Shield of Nebraska and Oscar Health and 2 other insurers list Jack Formanek as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Formanek was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.