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PINE LAKE HEALTH LLC
NPI 1417908666
Family Medicine in Lincoln, NE

Active since May 12, 2006CLIA 28D1054208 · Waiver
2611 S 70TH ST, LINCOLN, NE 68506(402) 423-4200(402) 423-4201 Get Directions Write a Review

NPPES record last updated: August 30, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 30, 2022, Sep 12, 2019 (2 updates tracked since 2019).

About Pine Lake Health Llc NPPES

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

PINE LAKE HEALTH LLC (NPI 1417908666) is a healthcare organization registered as a family medicine in Lincoln, Nebraska and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through June 6, 2028 and lists Matthew M Glenn, President, as its authorized official.

NPPES Registry Identity

NPI1417908666
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePINE LAKE HEALTH LLC
Location Address2611 S 70TH STLincoln, NE 68506-2960
Mailing Address2611 S 70th StLincoln, NE 68506-2960 · (402) 423-4200 · Fax (402) 423-4201
Phone(402) 423-4200
Fax(402) 423-4201
Organization SubpartNo
Authorized OfficialMatthew M GlennPresident · (402) 423-4200
Enumeration DateMay 12, 2006
Last NPPES UpdateAugust 30, 20222 updates tracked since enumeration
NPPES CertifiedAugust 30, 2022
✔ NPI 1417908666 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
2611 S 70TH ST, Lincoln, NE 68506
Open in Google Maps ↗

Other Identifiers 2

Other02800NE · Bcbs
Medicaid10025371800NE

Accepted Insurance

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 28D1054208

Pine Lake Health, LLC · Lincoln, NE
Active · expires Jun 6, 2028
CLIA Number28D1054208
Laboratory TypePhysician Office
Certificate Effective DateJune 7, 2026
Certificate Expiration DateJune 6, 2028
Laboratory DirectorDr. Matthew M. Glenn
Laboratory Phone(402) 423-4200
Laboratory LocationPine Lake Health, LLC2611 S 70th Street, Lincoln, NE 68506
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KYLIE PARSHALL PAC
Family Medicine
2611 S 70TH ST
LINCOLN, NE 68506
Lancaster County (402) 423-4200
LINDA KROEGER APRN
Family Medicine
2611 S 70TH ST
LINCOLN, NE 68506
Lancaster County (402) 423-4200
MATTHEW M GLENN MD
Family Medicine
2611 S 70TH ST
LINCOLN, NE 68506
Lancaster County (402) 423-4200
ROSS INTERNAL MEDICINE PC
Internal Medicine
2611 S 70TH ST, SUITE A
LINCOLN, NE 68506
Lancaster County (402) 362-7677
MEGAN SKRADIS APRN
Nurse Practitioner
2611 S 70TH ST
LINCOLN, NE 68506
Lancaster County (402) 423-4200
ALYSON FERGUSON APRN-FNP-C
Nurse Practitioner (Family)
2611 S 70TH ST
LINCOLN, NE 68506
Lancaster County (402) 423-4200

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 Pine Lake Health LLC's NPI number?

The NPI number for Pine Lake Health LLC is 1417908666. It was assigned to this organization in the NPPES registry on May 12, 2006.

Where is Pine Lake Health LLC located?

Pine Lake Health LLC is located at 2611 S 70th St, Lincoln, NE 68506. The listed phone number is (402) 423-4200.

What is Pine Lake Health LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Pine Lake Health LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 28D1054208) is associated with this NPI, valid through June 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pine Lake Health LLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Blue Cross and Blue Shield of Nebraska and 1 other insurer list Pine Lake Health LLC 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 Pine Lake Health LLC was last updated on August 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.