PINE LAKE HEALTH LLC
NPI 1417908666
Family Medicine in Lincoln, NE
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
Specialties & Licenses 4
Other Identifiers 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pine Lake Health Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Pine Lake Health LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 6 within 10 miles. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, NEFrequently 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.
Is Pine Lake Health LLC enrolled in Medicare?
Yes. Pine Lake Health LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pine Lake Health LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Pine Lake Health LLC. A 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 the clinician's services. The largest specialties are Nurse Practitioner (5) and Family Practice (1). Of these, 4 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Sunflower Health Plan and Blue Cross and Blue Shield of Nebraska 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 4 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.
# Pine Lake Health Llc · NPI 1417908666
Family Medicine organization in Lincoln, Nebraska. Organization record, active in the CMS NPPES registry since May 12, 2006.
## Identity
- **NPI:** 1417908666 (Entity type: Organization)
- **Enumerated:** May 12, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Matthew Glenn, PRESIDENT
## Practice location
- **Address:** 2611 S 70TH ST, Lincoln, NE 68506-2960
- **Phone:** (402) 423-4200 · **Fax:** (402) 423-4201
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (5), Family Practice (1); 4 practice at this address and 6 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 30, 2022
- **Other identifiers:** Other 02800 (NE); Medicaid 10025371800 (NE)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1417908666) · Data from the CMS NPPES public registry.