Kenton R. Amstutz, D.O.
Individual provider Active NPI Pediatrics Physician · Boys Town, NE
NPI 1003981069 · NPPES record last updated Feb 14, 2013
Key facts
- NPI
- 1003981069
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 165 (NE)
- Practice address
- 14080 Hospital Rd
Boys Town, NE 68010-7513 - Phone
- (402) 778-6900
- Fax
- (402) 778-6917
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091116000149 | NE | Practitioner - Pediatric Medicine | 5597803338 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 165 | NE | MD | Developmental - Behavioral Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Father Flanagan'S Boys' Home | Pediatrics | Current |
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
555 N 30th St
Omaha, NE 68131
Phone (402) 280-8100
16929 Frances St
Ste 101
Omaha, NE 68130
Phone (402) 758-5125
7205 W Center Rd
Ste 104
Omaha, NE 68124
Phone (402) 392-7684
6715 S 180th St
Omaha, NE 68135
Phone (531) 355-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 165 | NE | Yes |
| 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
Other providers in Boys Town, NE
- Allison Marie Aberson
- Dayna Akakpo
- Elise C Allen
- Geoffrey Scott Allison
- Julie K Almquist
- Sandra Andres
- Aliza Claire Baker
- Jennifer Frances Banfield
- Samantha Frances Barney
- Katie Bemis
All providers in Boys Town, NE · Pediatrics Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.