Organization Active NPI

Advanced Mobile Medicine LLC

  • Gerontology Nurse Practitioner
  • Bellevue, NE
National Provider Identifier
1134616212
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
ADVANCED MOBILE MEDICINE LLC
Practice address
1902 Harlan Dr
Bellevue, NE 68005-6602
Phone
(402) 934-3886
NPI assigned
Apr 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

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

Authorized official

Name
Reggie Ripple
Title
President
Phone
(402) 934-2356

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X 111120 NE
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

1902 Harlan Dr
Bellevue, NE 68005-6602

Mailing address

1902 Harlan Dr
Bellevue, NE 68005-6602
Phone (402) 934-3886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180814002481 NE Part B Supplier - Clinic/Group Practice 7719236462 Receives reassigned benefits from 7 practitioners
Practice locations: Bellevue, NE
O20191002002743 IA Part B Supplier - Clinic/Group Practice 7719236462 Receives reassigned benefits from 1 practitioner
Practice locations: Council Bluffs, IA

National Provider Directory

National Provider Directory

Locations

2331 Nash Blvd
Council Bluffs, IA 51501
Phone (402) 933-4450

Practitioners & affiliated clinicians

Practitioners 9

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": "1523750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1134616212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 HARLAN DR",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680056602",
            "telephone_number": "402-934-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 HARLAN DR",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680056602",
            "telephone_number": "402-934-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MOBILE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-15",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "RIPPLE",
        "authorized_official_first_name": "REGGIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-934-2356"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NE",
            "license": "111120",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.