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SOUTH SIDE CONVENIENT CARE INC
NPI 1679007249
Physician Assistant in Bellevue, NE

Active since April 20, 2017CLIA 28D2132142 · Waiver
4115 HARRISON ST, BELLEVUE, NE 68147(402) 932-0692(402) 614-6731 Get Directions Write a Review

NPPES record last updated: July 17, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 17, 2023, Jun 16, 2018, Aug 8, 2017 and 2 more (5 updates tracked since 2017).

About South Side Convenient Care Inc NPPES

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

SOUTH SIDE CONVENIENT CARE INC (NPI 1679007249) is a healthcare organization registered as a physician assistant in Bellevue, Nebraska and active in the NPI registry since April 2017. The organization holds a CLIA Waiver certificate valid through June 12, 2027 and lists Samantha Senanayaka, Clinic Credentialing Contact, as its authorized official.

NPPES Registry Identity

NPI1679007249
Entity TypeOrganization
Primary Taxonomy363A00000X
Legal Business NameSOUTH SIDE CONVENIENT CARE INC
Location Address4115 HARRISON STBellevue, NE 68147-1059
Mailing Address4115 Harrison StBellevue, NE 68147-1059 · (402) 932-0692 · Fax (402) 614-6731
Phone(402) 932-0692
Fax(402) 614-6731
Organization SubpartNo
Authorized OfficialSamantha SenanayakaClinic Credentialing Contact · (402) 350-7616
Enumeration DateApril 20, 2017
Last NPPES UpdateJuly 17, 20235 updates tracked since enumeration
NPPES CertifiedJuly 17, 2023
✔ NPI 1679007249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
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.
4115 HARRISON ST, Bellevue, NE 68147
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Other Identifiers 1

Medicaid10026666300NE

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 28D2132142

South Side Convenient Care · Bellevue, NE
Active · expires Jun 12, 2027
CLIA Number28D2132142
Laboratory TypePhysician Office
Certificate Effective DateJune 13, 2025
Certificate Expiration DateJune 12, 2027
Laboratory DirectorSamantha Senanayaka
Laboratory Phone(402) 932-0692
Laboratory LocationSouth Side Convenient Care4115 Harrison Street, Bellevue, NE 68147
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 2

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

ANTONIO B SAQUETON PC
Family Medicine
4115 HARRISON ST
OMAHA, NE 68147
Sarpy County (402) 978-5151
SAMANTHA SENANAYAKA MPAS, PA-C
Physician Assistant
4115 HARRISON ST
BELLEVUE, NE 68147
Sarpy County (402) 932-0692

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 South Side Convenient Care Inc's NPI number?

The NPI number for South Side Convenient Care Inc is 1679007249. It was assigned to this organization in the NPPES registry on April 20, 2017.

Where is South Side Convenient Care Inc located?

South Side Convenient Care Inc is located at 4115 Harrison St, Bellevue, NE 68147. The listed phone number is (402) 932-0692.

What is South Side Convenient Care Inc's specialty?

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

Does South Side Convenient Care Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 28D2132142) is associated with this NPI, valid through June 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does South Side Convenient Care Inc 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 South Side Convenient Care Inc 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 South Side Convenient Care Inc was last updated on July 17, 2023. 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.