NPIMap

Organization Active NPI

55 Mdos

  • Primary Care Clinic/Center
  • Offutt AFB, NE
National Provider Identifier
1881095669
Registry record updated Feb 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
55 MDOS
Practice address
2501 Capehart Rd
Offutt AFB, NE 68113-1043
Phone
(402) 232-8046
NPI assigned
Sep 11, 2014
Last updated
Feb 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2015

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

Authorized official

Name
Rama Bhyravabhotla, PA-C
Title
Director Ipap Phase 2 Program
Phone
(402) 232-8046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2501 Capehart Rd
Offutt AFB, NE 68113-1043

Mailing address

2501 Capehart Rd
Offutt AFB, NE 68113-1043

National Provider Directory

National Provider Directory
Tax ID family
United States Air Force29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1881095669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 CAPEHART RD",
            "city": "OFFUTT AFB",
            "state": "NE",
            "postal_code": "681131043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 CAPEHART RD",
            "city": "OFFUTT AFB",
            "state": "NE",
            "postal_code": "681131043",
            "telephone_number": "402-232-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "55 MDOS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-11",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "BHYRAVABHOTLA",
        "authorized_official_first_name": "RAMA",
        "authorized_official_title_or_position": "DIRECTOR IPAP PHASE 2 PROGRAM",
        "authorized_official_telephone_number": "402-232-8046",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Offutt AFB, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.