Jacob Matthew Bazar
Individual provider Active NPI Developmental Disabilities Clinic/Center · Ralston, NE
NPI 1831998483 · NPPES record last updated Mar 7, 2025
Key facts
- NPI
- 1831998483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Disabilities Clinic/Center 261QD1600X
- Practice address
- 5720 S 77TH St
Ralston, NE 68127-4202 - Phone
- (531) 200-0563
- NPI assigned
- Mar 7, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | Yes |
Addresses
Primary practice location
5720 S 77TH St
Ralston, NE 68127-4202
Mailing address
5720 S 77TH St
Ralston, NE 68127-4202
Phone (531) 200-0563
Other providers in Ralston, NE
- Zakariya E Abdela
- Michael W Adamowicz
- Mary J Arnold
- Ablavi Anais Ayivon Kpetessou
- Augustin Bakouan
- Linsey Bellinger
- Roxanne C Belmont
- Dorine Blodgett
- Betty Jane Broughton
- Stacey Marie Brun
All providers in Ralston, NE · Developmental Disabilities Clinic/Center in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.