NPIMap

Individual provider Active NPI

Lars E. Vanderbur, M.D.

  • Pediatrics Physician
  • Omaha, NE
National Provider Identifier
1093808545
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
22271 Issued in NE
Practice address
9202 West Dodge Road
Suite 101
Omaha, NE 68114
Phone
(402) 955-7500
Fax
(402) 955-7524
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 22271 NE Primary

Addresses

Primary practice location

9202 West Dodge Road
Suite 101
Omaha, NE 68114

Mailing address

8401 West Dodge Road
Suite 280
Omaha, NE 68114
Phone (402) 955-6877

Other identifiers 4

IdentifierTypeStateIssuer
239080OtherNEMIDLANDS CHOICE
47068937213MedicaidNE
565671MedicaidIA
2606OtherNEBCBS

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22271NEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Health Bergan Mercy Health System Past Accepting new patients
Children'S West Village Pointe - Diagnostic Services Past Accepting new patients
Children'S Physicians Pediatrics Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1093808545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 WEST DODGE ROAD",
            "address_2": "SUITE 280",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68114",
            "telephone_number": "402-955-6877",
            "fax_number": "402-955-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 WEST DODGE ROAD",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68114",
            "telephone_number": "402-955-7500",
            "fax_number": "402-955-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBUR",
        "first_name": "LARS",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "22271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "239080",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068937213",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "565671",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2606",
            "state": "NE"
        }
    ],
    "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 Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.