Individual provider Active NPI

John S Bruun, M.D.

  • Surgical Critical Care Physician
  • Nellis Afb, NV
National Provider Identifier
1679547137
Registry record updated Aug 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
15380 Issued in NV
Practice address
4700 Las Vegas Blvd N
Nellis Afb, NV 89191
Phone
(702) 653-3550
NPI assigned
Feb 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35.089020 OH
Surgical Critical Care Physician 2086S0102X 15380 NV Primary

Addresses

Primary practice location

4700 Las Vegas Blvd N
Nellis Afb, NV 89191

Mailing address

4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Phone (702) 653-3550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20090126000449 OH Practitioner - General Surgery 1658435318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Uniformed Services Uhs Fe Hebert School of Med, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

30 E Apple St
Suite 6258B
Dayton, OH 45409-2932
Phone (937) 208-5055

Hospital & facility affiliations

  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

Merit-based Incentive Payment System (MIPS)

Final score
84.17 of 100Reported as group
Quality
65.6
Promoting interoperability
100
Improvement activities
40
Cost
74.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.089020OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Apr 6, 2025 Accepting new patients
Premier Health Specialists Inc Family Medicine Current Accepting new patients
Premier Health Specialists Inc CurrentSince Apr 6, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Miami Valley Hospital Past Accepting new patients

Locations

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

30 E Apple St
Ste 6258B
Dayton, OH 45409
Phone (937) 208-3186

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 5

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 1

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535068800000",
    "number": "1679547137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "89191",
            "telephone_number": "702-653-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUUN",
        "first_name": "JOHN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2018-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.089020",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NV",
            "license": "15380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nellis Afb, NV

Sources for this page

Verify at the official NPI Registry.