Active NPI
Jeffrey Roger Nielsen, D.D.S.
- General Practice Dentistry
- Omaha, NE
National Provider Identifier
1215158126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4857
- Practice address
- 2456 South 120 Street
Omaha, NE 68144 - Phone
- (402) 333-1313
- Fax
- (402) 333-0777
- NPI assigned
- May 1, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4857 | NE | Primary |
Addresses
Primary practice location
2456 South 120 Street
Omaha, NE 68144
Mailing address
2456 South 120 Street
Omaha, NE 68144
Phone (402) 333-1313
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20-890642600 | Medicaid | NE |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150416001065 | NE | Order and Referring Only - Oral Surgery | 6406174754 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4857 | NE | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NBD Bel Drive LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215158126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2456 SOUTH 120 STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-333-1313",
"fax_number": "402-333-0777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2456 SOUTH 120 STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-333-1313",
"fax_number": "402-333-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "JEFFREY",
"middle_name": "ROGER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "4857",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20-890642600",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.