NPIMap

Organization Active NPI

Lincoln Pediatric Group LLC

  • Pediatrics Physician
  • Lincoln, NE
National Provider Identifier
1508389610
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LINCOLN PEDIATRIC GROUP LLC
Practice address
5625 S 62ND St Ste 100
Lincoln, NE 68516-3558
Phone
(402) 489-3834
Fax
(402) 489-5049
NPI assigned
Jul 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Katie Thompson
Title
Practice Administrator
Phone
(402) 489-3834

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

5625 S 62ND St Ste 100
Lincoln, NE 68516-3558

Mailing address

5625 S 62ND St Ste 100
Lincoln, NE 68516-3558
Phone (402) 489-3834

Other identifiers 1

IdentifierTypeStateIssuer
1083640130MedicaidNE

National Provider Directory

National Provider Directory
Tax ID family
Lincoln Pediatric Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4501 S 70th St
Ste 110
Lincoln, NE 68516
Phone (402) 489-3834

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1508389610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5625 S 62ND ST STE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685163558",
            "telephone_number": "402-489-3834",
            "fax_number": "402-489-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5625 S 62ND ST STE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685163558",
            "telephone_number": "402-489-3834",
            "fax_number": "402-489-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN PEDIATRIC GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "402-489-3834"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083640130",
            "state": "NE"
        }
    ],
    "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 Mar 20, 2024; 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.