NPIMap

Individual provider Active NPI

Beau Jackson Kildow, MD

  • Orthopaedic Surgery Physician
  • Omaha, NE
National Provider Identifier
1780002436
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
32634 Issued in NE
Practice address
4014 Leavenworth St
Omaha, NE 68105-1053
Phone
(402) 559-8000
NPI assigned
Mar 31, 2014
Last updated
Dec 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 32634 NE Primary
Orthopaedic Surgery Physician 207X00000X 2019-01041 NC

Addresses

Primary practice location

4014 Leavenworth St
Omaha, NE 68105-1053

Mailing address

988102 Nebraska Medical Ctr
Omaha, NE 68198-8102

Other identifiers 1

IdentifierTypeStateIssuer
0397730024OtherNCNSC#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NE2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190612002328 NC Practitioner - Orthopedic Surgery 1456684166 Reassigns benefits to 1 organization
I20200723001770 NE Practitioner - Orthopedic Surgery 1456684166 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Nebraska College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Unmc PhysiciansGroup PAC ID 6002728391, 1,490 clinicians

Practice addresses (Care Compare)

4014 Leavenworth St
Omaha, NE 68105-1053
Phone (402) 552-7928

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement100
Knee replacement110
Melanoma (skin cancer) excision15
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32634NEMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unmc Physicians CurrentSince Aug 1, 2020 Accepting new patients
Orthocarolina Orthopaedic Surgery Current Accepting new patients
Orthocarolina Orthopaedic Surgery CurrentSince May 13, 2019 Accepting new patients
Orthocarolina, PA Orthopaedic Surgery CurrentSince May 13, 2019 Accepting new patients
The Nebraska Medical Center Past Accepting new patients
Bellevue Medical Center LLC Past Accepting new patients

Locations

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

2001 Vail Ave
Ste 200
Charlotte, NC 28207
Phone (704) 323-2564

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

110 N 175th St
Omaha, NE 68118
Phone (402) 596-4000

17405 Burke St
Ste 10070
Omaha, NE 68118

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-5600

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1780002436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "988102 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681988102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 LEAVENWORTH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681051053",
            "telephone_number": "402-559-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILDOW",
        "first_name": "BEAU",
        "middle_name": "JACKSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-31",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NE",
            "license": "32634",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "2019-01041",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC#",
            "identifier": "0397730024",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.