Individual provider Active NPI

Jonathan H Rasmussen, D.O.

  • Diagnostic Radiology Physician
  • Nellis AFB, NV
National Provider Identifier
1063785749
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1135 Issued in NE
Practice address
4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone
(702) 653-2830
NPI assigned
Feb 11, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1135 NE Primary

Addresses

Primary practice location

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600

Mailing address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone (702) 653-2830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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
I20260106002948 WY Practitioner - Diagnostic Radiology 7113307265 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Nevada School of Medicine, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

111 S 5TH St
Douglas, WY 82633-2434

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1135NEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of Converse County CurrentSince Sep 1, 2025 Accepting new patients
Memorial Hospital of Converse County CurrentSince Sep 1, 2025 Accepting new patients

Locations

111 S 5th St
Douglas, WY 82633
Phone (307) 358-6200

111 S 5th St
Fl 4
Douglas, WY 82633
Phone (307) 358-6200

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1328918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1063785749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASMUSSEN",
        "first_name": "JONATHAN",
        "middle_name": "H",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-11",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "1135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nellis AFB, NV

Sources for this page

Verify at the official NPI Registry.