Individual provider Active NPI

Kenton R. Amstutz, D.O.

  • Pediatrics Physician
  • Boys Town, NE
National Provider Identifier
1003981069
Registry record updated Feb 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
165 Issued in NE
Practice address
14080 Hospital Rd
Boys Town, NE 68010-7513
Phone
(402) 778-6900
Fax
(402) 778-6917
NPI assigned
Nov 22, 2006
Last updated
Feb 14, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 165 NE Primary
Developmental - Behavioral Pediatrics Physician 2080P0006X 165 NE

Addresses

Primary practice location

14080 Hospital Rd
Boys Town, NE 68010-7513

Mailing address

555 N 30TH St
Omaha, NE 68131-2136
Phone (402) 280-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091116000149 NE Practitioner - Pediatric Medicine 5597803338 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Father Flanagan's Boys' Home Pediatrics CurrentSince Oct 27, 2009 Accepting new patients
ENT Services PC Past Accepting new patients
Father Flanagan's Boys Home Past Accepting new patients

Locations

14080 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6900

16929 Frances St
Ste 101
Omaha, NE 68130
Phone (402) 758-5125

555 N 30th St
Omaha, NE 68131
Phone (402) 280-8100

6715 S 180th St
Omaha, NE 68135
Phone (402) 996-2320

7205 W Center Rd
Ste 104
Omaha, NE 68124
Phone (402) 392-7684

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1003981069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N 30TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312136",
            "telephone_number": "402-280-8100",
            "fax_number": "402-280-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14080 HOSPITAL RD",
            "city": "BOYS TOWN",
            "state": "NE",
            "postal_code": "680107513",
            "telephone_number": "402-778-6900",
            "fax_number": "402-778-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMSTUTZ",
        "first_name": "KENTON",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "165",
            "primary": true
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NE",
            "license": "165",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boys Town, NE

Sources for this page

Verify at the official NPI Registry.