NPIMap

Individual provider Active NPI

Connor Evan Bliss, PA-C

  • Physician Assistant
  • Kearney, NE
National Provider Identifier
1851917181
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2505 Issued in NE
Practice address
2908 W 39TH St Ste D
Kearney, NE 68845-1245
Phone
(308) 455-8023
Fax
(308) 455-8024
NPI assigned
Jun 23, 2020
Last updated
Oct 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2505 NE Primary

Addresses

Primary practice location

2908 W 39TH St Ste D
Kearney, NE 68845-1245

Mailing address

603 N Diers Ave Ste 2
Grand Island, NE 68803-4987
Phone (308) 398-1147

Other practice location 1

603 N Diers Ave Ste 2
Grand Island, NE 68803-4987
Phone (308) 398-1147

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200915002474 NE Practitioner - Physician Assistant 3870911340 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bryan Hospital KearneyGroup PAC ID 5991195547, 116 clinicians

Practice addresses (Care Compare)

804 22ND Ave
Kearney, NE 68845-2206
Phone (308) 455-3600

816 22ND Ave
Suite 100
Kearney, NE 68845-2226
Phone (308) 865-2263

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bryan Hospital Kearney CurrentSince Mar 1, 2025 Accepting new patients
Schrock Medical Clinic PC CurrentSince May 16, 2022 Accepting new patients
Platte Valley Medical Group, P.C. Past Accepting new patients
Kearney Pain Treatment Center, LLC Past Accepting new patients

Locations

1616 W 39th St
Ste A
Kearney, NE 68845
Phone (308) 236-6499

804 22nd Ave
Kearney, NE 68845
Phone (308) 455-3600

816 22nd Ave
Ste 100
Kearney, NE 68845
Phone (308) 865-2263

Interoperability endpoints

  • Direct secure messaging: cbliss196411@hisp.bryanhealth.org

Organizations & group practices 5

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 5

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": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1851917181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 N DIERS AVE STE 2",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034987",
            "telephone_number": "308-398-1147",
            "fax_number": "308-398-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 W 39TH ST STE D",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688451245",
            "telephone_number": "308-455-8023",
            "fax_number": "308-455-8024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "603 N Diers Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Grand Island",
            "state": "NE",
            "postal_code": "688034987",
            "country_code": "US",
            "telephone_number": "308-398-1147",
            "fax_number": "308-398-1149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLISS",
        "first_name": "CONNOR",
        "middle_name": "EVAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

Verify at the official NPI Registry.