Active NPI
Edward V Vandenberg, MD
- Geriatric Medicine (Internal Medicine) Physician
- Omaha, NE
National Provider Identifier
1881644334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 13696
- Practice address
- 988102 Nebraska Medical Ctr
Omaha, NE 68198-8102 - Phone
- (402) 559-9600
- Fax
- (402) 559-8228
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 13696 | NE | Primary |
Addresses
Primary practice location
988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Mailing address
988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Phone (402) 559-9600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47078557525 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13696 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1881644334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "988102 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681988102",
"telephone_number": "402-559-9600",
"fax_number": "402-559-8228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "988102 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681988102",
"telephone_number": "402-559-9600",
"fax_number": "402-559-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENBERG",
"first_name": "EDWARD",
"middle_name": "V",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NE",
"license": "13696",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47078557525",
"state": "NE"
}
],
"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 Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.