Active NPI
Shane Dexter Penna
- Family Medicine Physician
- Omaha, NE
National Provider Identifier
1851282024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10396
- Practice address
- 983075 Nebraska Medical Ctr
Omaha, NE 68198-3075 - Phone
- (402) 595-2275
- NPI assigned
- Jul 14, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10396 | NE | Primary |
Addresses
Primary practice location
983075 Nebraska Medical Ctr
Omaha, NE 68198-3075
Mailing address
983075 Nebraska Medical Ctr
Omaha, NE 68198-3075
Phone (402) 595-2275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251104000200 | NE | Order and Referring Only - Family Practice | 8426548090 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10396 | NE | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1851282024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "983075 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681983075",
"telephone_number": "402-595-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "983075 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681983075",
"telephone_number": "402-595-2275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNA",
"first_name": "SHANE",
"middle_name": "DEXTER",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-14",
"last_updated": "2025-07-14",
"certification_date": "2025-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NE",
"license": "10396",
"primary": true
}
],
"identifiers": [],
"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 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.