Active NPI
Michael Xavier McIntosh, MD
- Ophthalmology Physician
- Omaha, NE
National Provider Identifier
1780754614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 11990
- Practice address
- 2732 South 87TH Street
Omaha, NE 68124 - Phone
- (402) 397-1117
- Fax
- (402) 397-1160
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 11990 | NE | Primary |
Addresses
Primary practice location
2732 South 87TH Street
Omaha, NE 68124
Mailing address
2732 South 87TH Street
Omaha, NE 68124
Phone (402) 397-1117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47055806600 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11990 | NE | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780754614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2732 SOUTH 87TH STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68124",
"telephone_number": "402-397-1117",
"fax_number": "402-397-1160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2732 SOUTH 87TH STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68124",
"telephone_number": "402-397-1117",
"fax_number": "402-397-1160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTOSH",
"first_name": "MICHAEL",
"middle_name": "XAVIER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NE",
"license": "11990",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47055806600",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.