NPIMap

Organization Active NPI

Cheney Ridge Family Medical Clinic, PC

  • General Practice Physician
  • Lincoln, NE
National Provider Identifier
1003044660
Registry record updated May 18, 2020
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Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
16656 Issued in NE
Legal business name
CHENEY RIDGE FAMILY MEDICAL CLINIC, PC
Practice address
3540 Village Dr
Suite 100
Lincoln, NE 68516-4706
Phone
(402) 420-7113
NPI assigned
Jun 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patrick J Bertolini
Title
President
Phone
(402) 420-7113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 16656 NE Primary

Addresses

Primary practice location

3540 Village Dr
Suite 100
Lincoln, NE 68516-4706

Mailing address

3540 Village Dr
Suite 100
Lincoln, NE 68516-4706
Phone (402) 420-7113

National Provider Directory

National Provider Directory

Locations

3540 Village Dr
Ste 100
Lincoln, NE 68516
Phone (402) 420-7113

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1003044660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 VILLAGE DR",
            "address_2": "SUITE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164706",
            "telephone_number": "402-420-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 VILLAGE DR",
            "address_2": "SUITE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685164706",
            "telephone_number": "402-420-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHENEY RIDGE FAMILY MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "BERTOLINI",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-420-7113"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "NE",
            "license": "16656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.