Active NPI
Derek J Tjepkes, PTA
- Physical Therapy Assistant
- Bellevue, NE
National Provider Identifier
1083127682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1632
- Practice address
- 1702 Hillcrest Dr
Bellevue, NE 68005-3652 - Phone
- (402) 682-4214
- NPI assigned
- Nov 6, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1632 | NE | Primary |
Addresses
Primary practice location
1702 Hillcrest Dr
Bellevue, NE 68005-3652
Mailing address
4707 N 176TH St
Omaha, NE 68116-1151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1632 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1632 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509926400000",
"number": "1083127682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4707 N 176TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681161151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 HILLCREST DR",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "680053652",
"telephone_number": "402-682-4214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TJEPKES",
"first_name": "DEREK",
"middle_name": "J",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-06",
"last_updated": "2017-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "1632",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1632",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.