NPIMap

Organization Active NPI

Bruce H Brumm MD PC

Doing business as Brumm Optical Boutique

  • Durable Medical Equipment & Medical Supplies
  • Omaha, NE
National Provider Identifier
1508878075
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
N/A Issued in NU
Legal business name
BRUCE H BRUMM MD PC
Doing business as
Brumm Optical Boutique
Practice address
17001 Lakeside Hills PLZ
Suite 101
Omaha, NE 68130-4670
Phone
(402) 934-7700
Fax
(402) 934-2555
NPI assigned
Aug 13, 2006
Last updated
Apr 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Authorized official

Name
Jennifer L Weaver
Title
Administrator
Phone
(402) 572-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X N/A NU Primary

Addresses

Primary practice location

17001 Lakeside Hills PLZ
Suite 101
Omaha, NE 68130-4670

Mailing address

6751 N 72ND St
Omaha, NE 68122-1746
Phone (402) 572-2020

Other names 1

  • Brumm Optical Boutique Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930035119 NE DME Supplier - Multi-Specialty - Physician 7315916186 Practice locations: Omaha, NE

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lem Tammy T OD2 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

17001 Lakeside Hills Plz
Ste 101
Omaha, NE 68130
Phone (402) 934-7700

6751 N 72nd St
Ste 105
Omaha, NE 68122
Phone (402) 572-2020

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1508878075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6751 N 72ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681221746",
            "telephone_number": "402-572-2020",
            "fax_number": "402-572-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17001 LAKESIDE HILLS PLZ",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304670",
            "telephone_number": "402-934-7700",
            "fax_number": "402-934-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE H BRUMM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "402-572-2020"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brumm Optical Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 17, 2008; 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.

Verify at the official NPI Registry.