Individual ProviderJohn BeckenhauerPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice AddressEmile @ 42nd St, Omaha, NE 68198-0001(402) 559-5000PECOS EnrollmentBased on the most recent information from CMS, provider John Beckenhauer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1811991789Provider TypeIndividualFull NameBeckenhauer, JohnCredentialPA-CGenderMaleSole ProprietorNoEnumeration Date6/9/2005Last Updated2/9/2021Contact InformationPractice LocationPractice AddressEmile @ 42nd St, Omaha, NE 68198-0001Phone(402) 559-5000FaxUnlisted FaxMailing LocationMailing Address988102 Nebraska Medical Ctr, Omaha, NE 68198-8102PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense961NebraskaCode363AS0400XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense961NebraskaProvider IdentifiersIDDescriptionIssuerID970030785DescriptionOtherIssuerRAILROAD MEDICARENebraskaID47081304012DescriptionMedicaidIssuerUnlistedNebraskaID37830DescriptionOtherIssuerBCBSNebraskaID68154A018DescriptionOtherIssuerTRICARENebraska