NPIMap

Individual provider Active NPI

Bao Tram Ngoc Huynh, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1215564117
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2420 Issued in NE
Practice address
2429 M St
Omaha, NE 68107-2715
Phone
(402) 227-6138
NPI assigned
Mar 23, 2020
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2420 NE
Physician Assistant 363A00000X 2420 NE Primary

Addresses

Primary practice location

2429 M St
Omaha, NE 68107-2715

Mailing address

6321 S 109TH St
Omaha, NE 68137-4716

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200428000047 NE Practitioner - Physician Assistant 7113357526 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harlan Medical LLCGroup PAC ID 8628206034, 11 clinicians
Hydr8 LLCGroup PAC ID 1456726884, 18 clinicians
4G Enterprises LLCGroup PAC ID 4789810508, 20 clinicians
Urgent Care Bennington, LLCGroup PAC ID 0446751994, 12 clinicians

Practice addresses (Care Compare)

1307 Harlan Dr
Bellevue, NE 68005-3699
Phone (402) 291-8701

18210 Wright St
Omaha, NE 68130-2883
Phone (531) 999-1813

2717 S 108TH St
Omaha, NE 68144-4811
Phone (402) 933-8201

8001 N 157TH St
Suite 102
Bennington, NE 68007-5191
Phone (531) 999-8744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2420NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellevue Urgent Care LP Current Accepting new patients
Urgent Care Group LLC Past Accepting new patients
Muc-Papillion LLC Past Accepting new patients

Locations

1307 Harlan Dr
Bellevue, NE 68005
Phone (402) 291-8701

Interoperability endpoints

  • Direct secure messaging: bao.tram.huynh.1@32282.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/25093/brand/1/csg/1/fhir/r4

Organizations & group practices 10

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": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1215564117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6321 S 109TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681374716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2429 M ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681072715",
            "telephone_number": "402-227-6138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUYNH",
        "first_name": "BAO TRAM",
        "middle_name": "NGOC",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "2420",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.