Active NPI
John Bagley, P.A.-C
- Physician Assistant
- Lincoln, NE
National Provider Identifier
1154519312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 794
- Practice address
- 4201 S 14TH St
Lincoln, NE 68502-5336 - Phone
- (402) 479-3292
- NPI assigned
- Oct 11, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 794 | NE | Primary |
Addresses
Primary practice location
4201 S 14TH St
Lincoln, NE 68502-5336
Mailing address
4201 S 14TH St
Lincoln, NE 68502-5336
Phone (402) 479-3292
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 794 | NE | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192060800000",
"number": "1154519312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 S 14TH ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685025336",
"telephone_number": "402-479-3292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 S 14TH ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685025336",
"telephone_number": "402-479-3292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGLEY",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-11",
"last_updated": "2007-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.