MALLORY LEIGH POTTEBAUM PA-C
NPI 1487950945
Physician Assistant in Omaha, NE

Q: What is Mallory Pottebaum's NPI number?

The NPI number for Mallory Pottebaum is 1487950945. It was assigned to this individual provider in the NPPES registry on February 1, 2011. The provider is also known as Mallory Leigh Johnson Pa-C.

Q: What is Mallory Pottebaum's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Mallory Pottebaum was last updated on June 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since February 01, 2011PECOS EnrolledAccepts Medicare Assignment

505 S. 45TH ST, OMAHA, NE 68198(402) 559-5600 Get Directions Write a Review

NPPES record last updated: June 25, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 21, 2017, Dec 23, 2015 (2 updates tracked since 2015).

On this page

About Mallory Leigh Pottebaum Pa-c NPPES

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

MALLORY LEIGH POTTEBAUM PA-C (NPI 1487950945) is an individual physician assistant in Omaha, Nebraska, licensed in Nebraska (1997) and active in the NPI registry since February 2011. She is enrolled in Medicare PECOS, is affiliated with The Nebraska Medical Center, and is a graduate of University Of Nebraska College Of Medicine (2015).

NPPES Registry Identity

NPI1487950945

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMALLORY LEIGH POTTEBAUMCredential: PA-C

Location Address505 S. 45TH STOmaha, NE 68198-0001

Mailing Address988102 Nebraska Medical CtrOmaha, NE 68198-8102

Phone(402) 559-5600

Sole ProprietorNo

Medical School CMSUniversity Of Nebraska College Of MedicineGraduated 2015

Enumeration DateFebruary 1, 2011

Last NPPES UpdateJune 25, 20192 updates tracked since enumeration

✔ NPI 1487950945 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NE · 1997

Definition

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.

505 S. 45TH ST, Omaha, NE 68198

Open in Google Maps ↗

Other Names 1

Former Name (1)Mallory Leigh Johnson Pa-c

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Nebraska, Medica, Oscar Insurance Company and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mallory Leigh Pottebaum Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9931401676

PECOS Enrollment IDI20160112001800

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.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

105 services89 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

41 services37 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

15 services15 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

The Nebraska Medical Center

Acute Care Hospitals · Omaha, NE

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number280013

Location987400 Nebraska Medical CenterOmaha, NE 68198 · Douglas County

Emergency services Birthing friendly

Bellevue Medical Center, LLC

Acute Care Hospitals · Bellevue, NE

5/5 CMS rating

OwnershipProprietary

CMS Certification Number280132

Location2500 Bellevue Medical Center DrBellevue, NE 68123 · Sarpy County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 68198 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.20 typical visit price

range $52.69 – $160.21

Typical copayment $20.30 (range $13.17 – $40.05)

Most-billed visit code 99203

Established Patient

$66.00 typical visit price

range $16.90 – $131.25

Typical copayment $16.50 (range $4.22 – $32.81)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

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

DR. MICHAEL BAINE M.D.

Radiology (Radiation Oncology)