Active NPI
Brock Carl Harnisch
- Radiation Oncology Physician
- Fremont, NE
National Provider Identifier
1700378577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 1476109
- Practice address
- 2230 E 12TH St
Fremont, NE 68025-1610 - Phone
- (312) 375-4601
- NPI assigned
- Jun 6, 2018
- 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 |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 1476109 | IN | Primary |
Addresses
Primary practice location
2230 E 12TH St
Fremont, NE 68025-1610
Mailing address
9089 Clairemont Mesa Blvd Ste 200
San Diego, CA 92123-1225
Phone (858) 810-8628
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1476109 | IN | MD | Radiation Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1700378577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9089 CLAIREMONT MESA BLVD STE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231225",
"telephone_number": "858-810-8628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2230 E 12TH ST",
"city": "FREMONT",
"state": "NE",
"postal_code": "680251610",
"telephone_number": "312-375-4601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARNISCH",
"first_name": "BROCK",
"middle_name": "CARL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-06",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IN",
"license": "1476109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.