Active NPI
Bruce William Henricks, MD
- Internal Medicine Physician
- Omaha, NE
National Provider Identifier
1700155389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 13082
- Practice address
- Mutual of Omaha PLZ
Ifs BLDG 3
Omaha, NE 68175-0001 - Phone
- (402) 351-5044
- Fax
- (402) 351-2552
- NPI assigned
- Dec 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 13082 | NE | Primary |
Addresses
Primary practice location
Mutual of Omaha PLZ
Ifs BLDG 3
Omaha, NE 68175-0001
Mailing address
Mutual of Omaha PLZ
Ifs BLDG 3
Omaha, NE 68175-0001
Phone (402) 351-5044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13082 | NE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325030400000",
"number": "1700155389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MUTUAL OF OMAHA PLZ",
"address_2": "IFS BLDG 3",
"city": "OMAHA",
"state": "NE",
"postal_code": "681750001",
"telephone_number": "402-351-5044",
"fax_number": "402-351-2552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MUTUAL OF OMAHA PLZ",
"address_2": "IFS BLDG 3",
"city": "OMAHA",
"state": "NE",
"postal_code": "681750001",
"telephone_number": "402-351-5044",
"fax_number": "402-351-2552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRICKS",
"first_name": "BRUCE",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-28",
"last_updated": "2011-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NE",
"license": "13082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.