Active NPI
Stacy Leigh Solomon, D.D.S.
- General Practice Dentistry
- Broken Bow, NE
National Provider Identifier
1720158280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6515
- Practice address
- 2021 S E St
Ste #5
Broken Bow, NE 68822-1848 - Phone
- (308) 767-2004
- Fax
- (308) 767-2006
- NPI assigned
- Nov 9, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6515 | NE | Primary |
Addresses
Primary practice location
2021 S E St
Ste #5
Broken Bow, NE 68822-1848
Mailing address
2021 S E St
Ste #5
Broken Bow, NE 68822-1848
Phone (308) 767-2004
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05178 | Other | NE | BCBS |
| 10025242100 | Medicaid | NE |
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 |
|---|---|---|---|
| 6515 | NE | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mpda Broken Bow LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327449600000",
"number": "1720158280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2021 S E ST",
"address_2": "STE #5",
"city": "BROKEN BOW",
"state": "NE",
"postal_code": "688221848",
"telephone_number": "308-767-2004",
"fax_number": "308-767-2006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 S E ST",
"address_2": "STE #5",
"city": "BROKEN BOW",
"state": "NE",
"postal_code": "688221848",
"telephone_number": "308-767-2004",
"fax_number": "308-767-2006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOLOMON",
"first_name": "STACY",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-09",
"last_updated": "2012-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "6515",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "05178",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025242100",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Bow, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.