Active NPI
Stefanie L Bolte
- Urology Physician
- Omaha, NE
National Provider Identifier
1104877018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 23778
- Practice address
- 10707 Pacific St
Suite 101
Omaha, NE 68114-4762 - Phone
- (402) 397-7989
- Fax
- (402) 393-7554
- NPI assigned
- May 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 44887 | WI | |
| Urology Physician | 208800000X | 23778 | NE | Primary |
| Urology Physician | 208800000X | 36776 | IA |
Addresses
Primary practice location
10707 Pacific St
Suite 101
Omaha, NE 68114-4762
Mailing address
PO Box 8577
Omaha, NE 68108-0577
Phone (402) 397-7989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 098396 | Other | NE | MEDICARE |
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 |
|---|---|---|---|
| 36776 | IA | MD | Urology Physician |
| 44887 | WI | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364342400000",
"number": "1104877018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8577",
"city": "OMAHA",
"state": "NE",
"postal_code": "681080577",
"telephone_number": "402-397-7989",
"fax_number": "402-397-8703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10707 PACIFIC ST",
"address_2": "SUITE 101",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144762",
"telephone_number": "402-397-7989",
"fax_number": "402-393-7554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTE",
"first_name": "STEFANIE",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-15",
"last_updated": "2013-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "WI",
"license": "44887",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NE",
"license": "23778",
"primary": true
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IA",
"license": "36776",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "098396",
"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 Mar 27, 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.