Jason C Bruce, M.D.
Individual provider Active NPI Pediatrics Physician · Omaha, NE
NPI 1720153703 · NPPES record last updated Feb 20, 2013
Key facts
- NPI
- 1720153703
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 23674 (NE)
- Practice address
- 555 N 30TH St
Omaha, NE 68131-2136 - Phone
- (402) 498-6540
- Fax
- (402) 498-6387
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Boys Town National Research Hospital |
Hospital | Corporate Officer W-2 Managing Employee Operational/Managerial Control |
Nov 9, 2020 Nov 9, 2020 Nov 9, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091116000181 | NE | Practitioner - Pediatric Medicine | 4385782127 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23674 | NE | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Father Flanagan'S Boys' Home | Pediatrics | Current |
Accepting new patients |
| ENT Services PC | Past | Accepting new patients | |
| Father Flanagan'S Boys' Home | Past | Accepting new patients | |
| Father Flanagan'S Boys Home | Past | Accepting new patients |
Locations
14080 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6900
555 N 30th St
Omaha, NE 68131
Phone (402) 280-8100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 23674 | NE | Yes |
Addresses
Primary practice location
555 N 30TH St
Omaha, NE 68131-2136
Mailing address
555 N 30TH St
Omaha, NE 68131-2136
Phone (402) 280-8100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0723270 | Medicaid | IA | |
| 1201600 | Medicaid | NE | |
| 1201602 | Medicaid | NE | |
| 32332 | Other | NE | BCBS OF NE |
| 1201603 | Medicaid | NE | |
| 1201587 | Medicaid | NE | |
| 1201599 | Medicaid | NE | |
| 1201605 | Medicaid | NE | |
| 1723270 | Medicaid | IA | |
| 251096 | Other | NE | MIDLANDS CHOICE |
| 1201598 | Medicaid | NE | |
| 1201601 | Medicaid | NE | |
| 1201604 | Medicaid | NE |
Other providers in Omaha, NE
- Bruce H Brumm MD PC
- Bruce H Brumm MD PC
- Bruce H Brumm MD PC
- Bruce H Brumm MD PC
- Diane Bruce
- Jessica Bruce
- Michenzie Bruce
- Ramanda Lynn Bruce
- Shaela Mariah Daiella Bruce
- Andrew Bruch
All providers in Omaha, NE · Pediatrics Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.