Active NPI
Theodore Pham, DO
- Pediatrics Physician
- Lincoln, NE
National Provider Identifier
1285165407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2271
- Practice address
- 3262 Salt Creek Cir
Lincoln, NE 68504-4761 - Phone
- (402) 465-5600
- Fax
- (402) 327-6074
- NPI assigned
- Mar 21, 2017
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0102205715 | VA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 2271 | NE | Primary |
Addresses
Primary practice location
3262 Salt Creek Cir
Lincoln, NE 68504-4761
Mailing address
3262 Salt Creek Cir
Lincoln, NE 68504-4761
Phone (402) 465-5600
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
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102205715 | VA | MD | Pediatrics Physician |
| 2271 | NE | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryan Medical Center | Multi-Specialty | Past | Accepting new patients |
| Complete Children'S Health, P.C. | Pediatrics | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Lincoln, NE
- NPI 1962610493
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1285165407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3262 SALT CREEK CIR",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685044761",
"telephone_number": "402-465-5600",
"fax_number": "402-327-6074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3262 SALT CREEK CIR",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685044761",
"telephone_number": "402-465-5600",
"fax_number": "402-327-6074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "THEODORE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-21",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "VA",
"license": "0102205715",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NE",
"license": "2271",
"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 Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.