Individual provider Active NPI

Benjamin Fago, MD

  • Emergency Medicine Physician
  • Hastings, NE
National Provider Identifier
1659494268
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
23561 Issued in NE
Practice address
715 N Saint Joseph Ave
Hastings, NE 68901-4451
Phone
(402) 461-5122
NPI assigned
Apr 9, 2007
Last updated
Oct 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 23561 NE Primary

Addresses

Primary practice location

715 N Saint Joseph Ave
Hastings, NE 68901-4451

Mailing address

715 N Saint Joseph Ave
Hastings, NE 68901-4451

Other identifiers 2

IdentifierTypeStateIssuer
10025588700MedicaidNE
P00623703OtherRAILROAD MEDICARE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070712000249 NE Practitioner - Emergency Medicine 9931209467 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23561NEMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Mary Lanning Memorial Hospital Association Emergency Medicine CurrentSince Feb 1, 2014 Accepting new patients
The Mary Lanning Memorial Hospital Association CurrentSince Feb 1, 2014 Accepting new patients
North Platte Nebraska Physician Group LLC Emergency Medicine Past Accepting new patients

Locations

715 N Saint Joseph Ave
Hastings, NE 68901
Phone (402) 461-5036

815 N Kansas Ave
Hastings, NE 68901
Phone (402) 460-5899

601 W Leota St
North Platte, NE 69101
Phone (308) 534-2288

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1659494268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 N SAINT JOSEPH AVE",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689014451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 N SAINT JOSEPH AVE",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689014451",
            "telephone_number": "402-461-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGO",
        "first_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NE",
            "license": "23561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025588700",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00623703",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hastings, NE

Sources for this page

Verify at the official NPI Registry.