Individual provider Active NPI

Ryan Bruce Isherwood, M.D.

  • Family Medicine Physician
  • Gretna, NE
National Provider Identifier
1346446234
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TEP 5427 Issued in NE
Practice address
11946 Standing Stone Dr
Gretna, NE 68028-8094
Phone
(402) 815-4500
Fax
(402) 815-4510
NPI assigned
Jun 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TEP 5427 NE Primary

Addresses

Primary practice location

11946 Standing Stone Dr
Gretna, NE 68028-8094

Mailing address

PO Box 3755
Omaha, NE 68103-0755
Phone (402) 354-2100

Other identifiers 5

IdentifierTypeStateIssuer
47068731741MedicaidNE
47068731734MedicaidNE
10026480100MedicaidNE
1346446234MedicaidIA
47068731749MedicaidNE

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090723000071 NE Practitioner - Family Practice 1456403369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

11946 Standing Stone Dr
Gretna, NE 68028-8094
Phone (402) 815-4500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions11
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TEP 5427NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Family Medicine CurrentSince Jul 1, 2015 Accepting new patients
Alegent Creighton Clinic Family Medicine Past Accepting new patients

Locations

11946 Standing Stone Dr
Gretna, NE 68028
Phone (402) 815-4500

10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

101 E Centennial Rd
Papillion, NE 68046
Phone (402) 354-7750

Interoperability endpoints

  • Direct secure messaging: ryan.isherwood@direct.nmhs.org

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1346446234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3755",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681030755",
            "telephone_number": "402-354-2100",
            "fax_number": "402-354-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11946 STANDING STONE DR",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680288094",
            "telephone_number": "402-815-4500",
            "fax_number": "402-815-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHERWOOD",
        "first_name": "RYAN",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "TEP 5427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731741",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731734",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026480100",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346446234",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731749",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, NE

Sources for this page

Verify at the official NPI Registry.