NPIMap

Organization Active NPI

Prairie Orthopaedic & Plastic Surgery, P.C.

  • Ambulatory Surgical Clinic/Center
  • Lincoln, NE
National Provider Identifier
1255809620
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.
Practice address
4130 Pioneer Woods Dr Ste 1
Lincoln, NE 68506-7552
Phone
(402) 489-4700
Fax
(402) 489-5220
NPI assigned
Nov 5, 2018
Organization subpart
Yes
Parent organization
PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Authorized official

Name
Patrick T Hurlbut, MD
Title
Vice President
Phone
(402) 489-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

4130 Pioneer Woods Dr Ste 1
Lincoln, NE 68506-7552

Mailing address

4130 Pioneer Woods Dr Ste 1
Lincoln, NE 68506-7552
Phone (402) 489-4700

Other names 1

  • Prairie ASC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221201001394 NE Part B Supplier - Ambulatory Surgical Center 0345344818 Practice locations: Lincoln, NE

Ambulatory surgical center certification: CCN 28C0001069

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Prairie Orthopaedic & Plastic Surgery, PC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 14, 2024
Last certification
May 16, 2024
Facility address
4130 Pioneer Woods Dr, Suite 1
Lincoln, NE 68506

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Prairie Orthopaedic PC2 organizations share this tax ID, including this one
Part of
Prairie Orthopaedic PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1255809620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 PIONEER WOODS DR STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067552",
            "telephone_number": "402-489-4700",
            "fax_number": "402-489-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 PIONEER WOODS DR STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067552",
            "telephone_number": "402-489-4700",
            "fax_number": "402-489-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.",
        "enumeration_date": "2018-11-05",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "HURLBUT",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "402-489-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie ASC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.