Individual provider Active NPI

Kassidy Bruhn, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1508589409
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2893 Issued in NE
Practice address
361 N 46TH St Apt 3117
Omaha, NE 68132-3271
Phone
(605) 323-7011
NPI assigned
Sep 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 2893 NE Primary

Addresses

Primary practice location

361 N 46TH St Apt 3117
Omaha, NE 68132-3271

Mailing address

361 N 46TH St Apt 3117
Omaha, NE 68132-3271
Phone (605) 323-7011

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230621001497 NE Practitioner - Physician Assistant 7618335845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

4014 Leavenworth St
Omaha, NE 68105-1053
Phone (402) 552-7928

Emile 42ND St
Omaha, NE 68198-0001
Phone (402) 559-4015

Hospital & facility affiliations

  • The Nebraska Medical Center Hospital, Omaha, NE, CCN 280013
  • Bellevue Medical Center Hospital, Bellevue, NE, CCN 280132

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2893NEMDMental Health Counselor

Interoperability endpoints

  • Direct secure messaging: kkruger342089@direct.nebraskamed.com

Organizations & group practices 1

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 2

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": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1508589409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 N 46TH ST APT 3117",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681323271",
            "telephone_number": "605-323-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 N 46TH ST APT 3117",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681323271",
            "telephone_number": "605-323-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUHN",
        "first_name": "KASSIDY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.