Mrs Jordan Amber Haake, APRN is a medicare enrolled "Nurse Practitioner - Family" in Gothenburg, Nebraska. Her current practice location is
910 20th St, Gothenburg, Nebraska. You can reach out to her office (for appointments etc.) via phone at
(308) 537-3661.
Mrs Jordan Amber Haake is licensed to practice in Nebraska (license number 115387) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1104666734.
Provider's Profile
Full Name | Mrs Jordan Amber Haake |
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Gender | Female |
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Speciality | Nurse Practitioner - Family |
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Location | 910 20th St, Gothenburg, Nebraska |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1104666734
- Provider Enumeration Date: 05/30/2024
- Last Update Date: 06/27/2024
Medicare PECOS Information:
- PECOS PAC ID: 0143769638
- Enrollment ID: I20240828002994
Medical Identifiers
Medical identifiers for Mrs Jordan Amber Haake such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1104666734 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363LF0000X | Nurse Practitioner - Family | 115387 (Nebraska) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Jordan Amber Haake allows following entities to bill medicare on her behalf.
Entity Name | Gothenburg Memorial Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1922051531 PECOS PAC ID: 6709832983 Enrollment ID: O20050330001110 |
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Entity Name | Gothenburg Memorial Hospital |
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Entity Type | Part A Provider - Critical Access Hospital |
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Entity Identifiers | NPI Number: 1922051531 PECOS PAC ID: 6709832983 Enrollment ID: O20070123000252 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Jordan Amber Haake is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mrs Jordan Amber Haake, APRN 1016 22nd St, Gothenburg, NE 69138-2507 Ph: (308) 529-0350 | Mrs Jordan Amber Haake, APRN 910 20th St, Gothenburg, NE 69138-1237 Ph: (308) 537-3661 |
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