Active NPI
Omaha Orthopedic Clinic & Sports Medicine PC
- Orthopaedic Surgery Physician
- Omaha, NE
National Provider Identifier
1497720155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- OMAHA ORTHOPEDIC CLINIC & SPORTS MEDICINE PC
- Practice address
- 11704 W Center Rd
Ste 200
Omaha, NE 68144-4375 - Phone
- (402) 691-0500
- Fax
- (402) 691-1586
- NPI assigned
- Feb 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Peter M Cimino, MD
- Title
- President
- Phone
- (402) 691-0500
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | Primary |
Addresses
Primary practice location
11704 W Center Rd
Ste 200
Omaha, NE 68144-4375
Mailing address
11704 W Center Rd
Ste 200
Omaha, NE 68144-4375
Phone (402) 691-0500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CJ6643 | Other | NE | RR MEDICARE GROUP |
| I16089 | Other | IA | IA MEDICARE GROUP |
| 09283 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE, IA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040304001209 | NE | Part B Supplier - Clinic/Group Practice | 3779471545 |
Receives reassigned benefits from 8 practitioners Practice locations: Omaha, NE |
| O20050929000693 | IA | Part B Supplier - Clinic/Group Practice | 3779471545 |
Receives reassigned benefits from 2 practitioners Practice locations: Corning, IA; Missouri Valley, IA |
National Provider Directory
National Provider DirectoryLocations
11704 W Center Rd
Ste 200
Omaha, NE 68144
Phone (402) 691-0500
401 E Gold Coast Rd
Ste 230
Papillion, NE 68046
Phone (402) 592-5544
Practitioners & affiliated clinicians
Practitioners 30
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Omaha, NE
- NPI 1932173770
NE, Orthopaedic Surgery
-
- Orthopaedic Hand Surgery Physician
- Omaha, NE
- NPI 1215138607
IA, NE, Orthopaedic Surgery
-
- Surgical Technologist
- Omaha, NE
- NPI 1780196584
-
- Occupational Therapist
- Springfield, NE
- NPI 1104959725
-
- Physical Therapy Assistant
- Omaha, NE
- NPI 1851751812
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Elkhorn, NE
- NPI 1801827431
Orthopaedic Surgery
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1612396800000",
"number": "1497720155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11704 W CENTER RD",
"address_2": "STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681444375",
"telephone_number": "402-691-0500",
"fax_number": "402-691-1586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11704 W CENTER RD",
"address_2": "STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681444375",
"telephone_number": "402-691-0500",
"fax_number": "402-691-1586"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OMAHA ORTHOPEDIC CLINIC & SPORTS MEDICINE PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-17",
"last_updated": "2021-02-04",
"certification_date": "2021-02-04",
"status": "A",
"authorized_official_last_name": "CIMINO",
"authorized_official_first_name": "PETER",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "402-691-0500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CJ6643",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA MEDICARE GROUP",
"identifier": "I16089",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09283",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
- Omaha One Opco LLC
- Omaha Operations LLC
- Omaha Opportunities Industrialization Center
- Omaha Oral Surgery, LLC
- Omaha Orthodontics LLC
- Omaha Orthopedic Physical Therapy
- Omaha Pain Management Center Inc
- Omaha Pain Specialists, LLC
- Omaha Periodontics and Implant Dentistry LLC
- Omaha Physical Therapy Institute, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.