Individual provider Active NPI

Mallory Marie Rupp, D.C.

  • Chiropractor
  • Omaha, NE
National Provider Identifier
1093011843
Registry record updated Jan 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1646 Issued in NE
Practice address
14609 Ames PLZ
Apt. 102
Omaha, NE 68116-1505
Phone
(913) 626-0342
NPI assigned
Jan 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1646 NE Primary

Addresses

Primary practice location

14609 Ames PLZ
Apt. 102
Omaha, NE 68116-1505

Mailing address

14609 Ames PLZ
Apt. 102
Omaha, NE 68116-1505
Phone (913) 626-0342

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110421000271 NE Practitioner - Chiropractic 8820273667 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1646NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rupp Chiropractic & Advanced Nutrition LLC Chiropractor CurrentSince Jan 1, 2011 Accepting new patients

Locations

14264 W Maple Rd
Omaha, NE 68164
Phone (402) 305-3333

Organizations & group practices 1

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": "1296000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296000000000",
    "number": "1093011843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14609 AMES PLZ",
            "address_2": "APT. 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681161505",
            "telephone_number": "913-626-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14609 AMES PLZ",
            "address_2": "APT. 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681161505",
            "telephone_number": "913-626-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPP",
        "first_name": "MALLORY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-26",
        "last_updated": "2011-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1646",
            "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 Jan 26, 2011; 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.