NPIMap

Organization Active NPI

Bott PC

  • Family Medicine Physician
  • Omaha, NE
National Provider Identifier
1003284050
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOTT PC
Practice address
11810 Nicholas St Ste 101
Omaha, NE 68154-4414
Phone
(402) 779-8400
Fax
(402) 779-8401
NPI assigned
Sep 8, 2015
Last updated
May 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Authorized official

Name
Matthew S Bott, MDNPI 1982613790
Title
President
Phone
(402) 779-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11810 Nicholas St Ste 101
Omaha, NE 68154-4414

Mailing address

11810 Nicholas St Ste 101
Omaha, NE 68154-4414
Phone (402) 779-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151113000145 NE Part B Supplier - Clinic/Group Practice 3779893276 Receives reassigned benefits from 1 practitioner
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Locations

11810 Nicholas St
Ste 100
Omaha, NE 68154
Phone (402) 779-8400

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1003284050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11810 NICHOLAS ST STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681544414",
            "telephone_number": "402-779-8400",
            "fax_number": "402-779-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11810 NICHOLAS ST STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681544414",
            "telephone_number": "402-779-8400",
            "fax_number": "402-779-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "BOTT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-779-8400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.