Active NPI
Stephen C Raynor, MD
- Pediatric Surgery Physician
- Omaha, NE
National Provider Identifier
1104876507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 16699
- Practice address
- Children'S Hospital - Pediatric Surgery
8200 Dodge Street
Omaha, NE 68114-4113 - Phone
- (402) 955-7400
- Fax
- (402) 955-7405
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 16699 | NE | Primary |
Addresses
Primary practice location
Children'S Hospital - Pediatric Surgery
8200 Dodge Street
Omaha, NE 68114-4113
Mailing address
Children'S Hospital
8200 Dodge Street
Omaha, NE 68114-4113
Phone (405) 955-5400
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 580 | Other | MIDLANDS CHOICE | |
| 269802 | Other | COVENTRY | |
| 4082052 | Other | AETNA | |
| 01204 | Other | NE | BCBS |
| 17-00016 | Other | UHC | |
| 2946772 | Medicaid | IA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16699 | NE | MD | Pediatric Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104876507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CHILDREN'S HOSPITAL",
"address_2": "8200 DODGE STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144113",
"telephone_number": "405-955-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CHILDREN'S HOSPITAL - PEDIATRIC SURGERY",
"address_2": "8200 DODGE STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144113",
"telephone_number": "402-955-7400",
"fax_number": "402-955-7405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYNOR",
"first_name": "STEPHEN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "NE",
"license": "16699",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "580",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "269802",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4082052",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01204",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "17-00016",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2946772",
"state": "IA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.