NPIMap

Individual provider Active NPI

Kevin C Sisk, D.O.

  • Family Medicine Physician
  • Blair, NE
National Provider Identifier
1629330535
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1178 Issued in NE
Practice address
812 N 22ND St
Blair, NE 68008-1128
Phone
(402) 426-4611
Fax
(402) 426-4642
NPI assigned
Jun 15, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2015015493 MO
Family Medicine Physician 207Q00000X 1178 NE Primary

Addresses

Primary practice location

812 N 22ND St
Blair, NE 68008-1128

Mailing address

810 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-2182

Other practice location 1

2501 Capehart Rd
Offutt AFB, NE 68113-1043
Phone (402) 294-2056

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160728000154 NE Practitioner - Family Practice 3779716824 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Community Hospital Corporation 27 clinicians

Practice addresses (Care Compare)

3519 Hwy 32
Tekamah, NE 68061-5095
Phone (402) 374-1585

4929 County Rd
P43
Fort Calhoun, NE 68023-5066
Phone (402) 468-4655

810 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-2182

812 N 22ND St
Blair, NE 68008-1128
Phone (402) 426-4611

Hospital & facility affiliations

  • Nye Home Health Care Home health agency, Fremont, NE, CCN 287157
  • Memorial Community Hospital & Health System Hospital, Blair, NE, CCN 281359
  • CHI Health Bergan Mercy Hospital, Omaha, NE, CCN 280060
  • Good Shepherd Lutheran Home Nursing home, Blair, NE, CCN 285148
  • Accura HealthCare of Tekamah Nursing home, Tekamah, NE, CCN 285118
  • Crowell Memorial Home Nursing home, Blair, NE, CCN 285210

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1178NEMDClinical Social Worker
2015015493MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Community Hospital Corporation Family Medicine CurrentSince Oct 14, 2019 Accepting new patients
Memorial Community Hospital Corporation CurrentSince Oct 14, 2019 Accepting new patients
Crowell Memorial Home Past Accepting new patients

Locations

810 N 22nd St
Blair, NE 68008
Phone (402) 426-1116

812 N 22nd St
Blair, NE 68008
Phone (402) 426-4611

Organizations & group practices 8

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 7

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": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1629330535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-4611",
            "fax_number": "402-426-4642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Capehart Rd",
            "address_purpose": "LOCATION",
            "city": "Offutt AFB",
            "state": "NE",
            "postal_code": "681131043",
            "country_code": "US",
            "telephone_number": "402-294-2056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISK",
        "first_name": "KEVIN",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-15",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2015015493",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "1178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blair, NE

Sources for this page

Verify at the official NPI Registry.