NPIMap

Organization Active NPI

Nebraska Lower Extremity Surgery Group, LLC

  • Foot & Ankle Surgery Podiatrist
  • Omaha, NE
National Provider Identifier
1114343449
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
289 Issued in NE
Legal business name
NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
Practice address
1301 N 72ND St
Omaha, NE 68114-1903
Phone
(402) 991-8999
Fax
(402) 331-6537
NPI assigned
Mar 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Chad A Summy, DMP
Title
Owner
Phone
(402) 991-8999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 289 NE Primary

Addresses

Primary practice location

1301 N 72ND St
Omaha, NE 68114-1903

Mailing address

2705 Samson Way
Bellevue, NE 68123-4307
Phone (402) 991-8999

Other identifiers 1

IdentifierTypeStateIssuer
10026123800MedicaidNE

Other names 1

  • Foot and Ankle Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111123000333 NE DME Supplier - Physician - PodiatryDME Supplier - Independently-Practicing Physical Therapist 0547448953 Practice locations: Omaha, NE

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Nebraska Lower Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

18010 R Plz
Ste 106
Omaha, NE 68135
Phone (402) 991-8999

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1114343449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 SAMSON WAY",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681234307",
            "telephone_number": "402-991-8999",
            "fax_number": "402-331-6537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N 72ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681141903",
            "telephone_number": "402-991-8999",
            "fax_number": "402-331-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "SUMMY",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-991-8999",
        "authorized_official_credential": "DMP"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NE",
            "license": "289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026123800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foot and Ankle Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Foot and Ankle Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 28, 2020; 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.