NPIMap

Organization Active NPI

Jack K Lewis MD PC

  • Internal Medicine Physician
  • Omaha, NE
National Provider Identifier
1760563373
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10515 Issued in NE
Legal business name
JACK K LEWIS MD PC
Practice address
220 N 89TH St
Suite 101
Omaha, NE 68114-4072
Phone
(402) 393-3616
Fax
(402) 393-4347
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

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

Authorized official

Name
Jack K Lewis, MD
Title
President
Phone
(402) 393-3616

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 10515 NE Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X 778 NE

Addresses

Primary practice location

220 N 89TH St
Suite 101
Omaha, NE 68114-4072

Mailing address

220 N 89TH St
Suite 101
Omaha, NE 68114-4072
Phone (402) 393-3616

Other identifiers 1

IdentifierTypeStateIssuer
10026059900MedicaidNE

National Provider Directory

National Provider Directory

Locations

220 N 89th St
Omaha, NE 68114
Phone (402) 393-3616

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378684800000",
    "number": "1760563373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N 89TH ST",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144072",
            "telephone_number": "402-393-3616",
            "fax_number": "402-393-4347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N 89TH ST",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144072",
            "telephone_number": "402-393-3616",
            "fax_number": "402-393-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK K LEWIS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2013-09-09",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-393-3616",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "10515",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "778",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026059900",
            "state": "NE"
        }
    ],
    "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 Sep 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.