Individual provider Active NPI

Jacob Aaron Hettenbaugh

  • Internal Medicine Physician
  • Omaha, NE
National Provider Identifier
1144758368
Registry record updated Jun 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
7925 Issued in NE
Practice address
42 S ND and Emile St
Omaha, NE 68198-0001
Phone
(402) 559-4000
NPI assigned
Jun 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 7925 NE Primary

Addresses

Primary practice location

42 S ND and Emile St
Omaha, NE 68198-0001

Mailing address

42 S ND and Emile St
Omaha, NE 68198-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220524003270 NE Practitioner - Nephrology 7810261377 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

Emile 42ND St
Omaha, NE 68198-0001
Phone (402) 559-4015

Hospital & facility affiliations

  • DCI - Spring Street Dialysis facility, Omaha, NE, CCN 282536
  • The Nebraska Medical Center Hospital, Omaha, NE, CCN 280013
  • Bellevue Medical Center Hospital, Bellevue, NE, CCN 280132

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7925NEMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Madonna Rehabilitation Hospital CurrentSince Jul 1, 2022 Accepting new patients
Unmc Physicians CurrentSince Jul 1, 2022 Accepting new patients

Locations

5401 South St
Lincoln, NE 68506
Phone (402) 413-3000

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-5600

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496275200000",
    "number": "1144758368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 S ND AND EMILE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681980001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 S ND AND EMILE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681980001",
            "telephone_number": "402-559-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETTENBAUGH",
        "first_name": "JACOB",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2017-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "7925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.