Active NPI
Jacqueline Lynn Bertelsen, RD, LD, LMNT
- Registered Dietitian
- Omaha, NE
National Provider Identifier
1427181692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 345
- Practice address
- 8111 Dodge St Ste 332
Omaha, NE 68114-4119 - Phone
- (402) 354-5947
- Fax
- (403) 354-5651
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 345 | NE | Primary |
| Registered Dietitian | 133V00000X | R011922 | IA | |
| Registered Dietitian | 133V00000X | 00248 | IA |
Addresses
Primary practice location
8111 Dodge St Ste 332
Omaha, NE 68114-4119
Mailing address
PO Box 2797
Omaha, NE 68103-2797
Phone (402) 354-4230
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R011922 | Other | IA | AMERICAN DIETETIC ASSOC |
| 00248 | Other | IA | IOWA DIETETIC LICENSE |
| 345 | Other | NE | NEBRASKA DIETETIC LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R011922 | IA | MD | Registered Dietitian |
| 345 | NE | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1427181692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2797",
"city": "OMAHA",
"state": "NE",
"postal_code": "681032797",
"telephone_number": "402-354-4230",
"fax_number": "402-354-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8111 DODGE ST STE 332",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144119",
"telephone_number": "402-354-5947",
"fax_number": "403-354-5651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTELSEN",
"first_name": "JACQUELINE",
"middle_name": "LYNN",
"credential": "RD, LD, LMNT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NE",
"license": "345",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "R011922",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "00248",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN DIETETIC ASSOC",
"identifier": "R011922",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA DIETETIC LICENSE",
"identifier": "00248",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEBRASKA DIETETIC LICENSE",
"identifier": "345",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.