NPIMap

Individual provider Active NPI

Stephan Kermit Woodman, M.D.

  • Diagnostic Radiology Physician
  • Grand Island, NE
National Provider Identifier
1285662825
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
12780 Issued in NE
Practice address
2620 W Faidley Ave
Grand Island, NE 68803-4205
Phone
(308) 382-6856
Fax
(308) 381-1560
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 12780 NE Primary
Diagnostic Radiology Physician 2085R0202X 0430987 KS
Diagnostic Radiology Physician 2085R0202X 36619 IA

Addresses

Primary practice location

2620 W Faidley Ave
Grand Island, NE 68803-4205

Mailing address

2808 Old Fair Rd
Grand Island, NE 68803-5220
Phone (308) 382-6856

Other identifiers 1

IdentifierTypeStateIssuer
00422OtherNEBLUE CROSS BLUE SHIELD

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0430987KSMDDiagnostic Radiology Physician
12780NEMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Francis Medical Center Past Accepting new patients
Heartland Imaging Specialists LLC Diagnostic Radiology Past Accepting new patients
Grand Island Radiology Associates PC Diagnostic Radiology Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1285662825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 OLD FAIR RD",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688035220",
            "telephone_number": "308-382-6856",
            "fax_number": "308-381-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034205",
            "telephone_number": "308-382-6856",
            "fax_number": "308-381-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODMAN",
        "first_name": "STEPHAN",
        "middle_name": "KERMIT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "12780",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KS",
            "license": "0430987",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "36619",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00422",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.