Individual provider Active NPI

Jose Angel Mayorquin, M.D.

  • Family Medicine Physician
  • Omaha, NE
National Provider Identifier
1881009884
Registry record updated Jul 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28875 Issued in NE
Practice address
4220 L St
Omaha, NE 68107-1048
Phone
(402) 733-4433
Fax
(402) 733-1220
NPI assigned
Jun 27, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28875 NE Primary
Family Medicine Physician 207Q00000X 7173 NE

Addresses

Primary practice location

4220 L St
Omaha, NE 68107-1048

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (402) 733-4433

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160912002352 NE Practitioner - Family PracticePractitioner - Emergency Medicine 4082833108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2727 S 144TH St
150 Emergency Department
Omaha, NE 68144-5225
Phone (402) 609-1500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7173NEMDFamily Medicine Physician

Organizations & group practices 1

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

Hospital & facility affiliations 1

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": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499990400000",
    "number": "1881009884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "402-733-4433",
            "fax_number": "402-733-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 L ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071048",
            "telephone_number": "402-733-4433",
            "fax_number": "402-733-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYORQUIN",
        "first_name": "JOSE",
        "middle_name": "ANGEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2017-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "28875",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "7173",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.