Bloomfield Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25844 Issued in NE

Legal business name

BLOOMFIELD MEDICAL CLINIC

Doing business as

Bloomfield Medical Clinic DBA Osmond Medical Clinic

Practice address

418 N State St
Osmond, NE 68765-5722

Phone

(402) 748-3366

Fax

(402) 373-4344

NPI assigned

Sep 30, 2016

Last updated

Sep 30, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

BLOOMFIELD MEDICAL CLINIC PCAs reported in NPPES

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

Authorized official

Name

Kevin D Lauck, PA-CNPI 1598713885

Title

President

Phone

(402) 373-4341

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Bloomfield Medical Clinic DBA Osmond Medical Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Bloomfield Medical Clinic P

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bloomfield Medical Clinic, PC

  • Medical Physician Assistant
  • Bloomfield, NE
  • NPI 1003091497
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin D. Lauck, PA-C

  • Physician Assistant
  • Bloomfield, NE
  • NPI 1598713885
  Authorized official Same address or phone
• Riley Glee Eckmann, MD

  • Family Medicine Physician
  • Bloomfield, NE
  • NPI 1447487129
  NPD

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

{
    "created_epoch": "1475193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1902355951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S BROADWAY ST",
            "address_2": "PO BOX 357",
            "city": "BLOOMFIELD",
            "state": "NE",
            "postal_code": "687184419",
            "telephone_number": "402-373-4341",
            "fax_number": "402-373-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 N STATE ST",
            "city": "OSMOND",
            "state": "NE",
            "postal_code": "687655722",
            "telephone_number": "402-748-3366",
            "fax_number": "402-373-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMFIELD MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLOOMFIELD MEDICAL CLINIC PC",
        "enumeration_date": "2016-09-30",
        "last_updated": "2016-09-30",
        "status": "A",
        "authorized_official_last_name": "LAUCK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-373-4341",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "25844",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1040",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2003",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "110153",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025588500",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloomfield Medical Clinic DBA Osmond Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Family First Dental Associates of Wausa, P.C. (Family 1st Dental of Osmond)
• Connor Paul Gutz
• David F Johnson Jr., MD
• David Byron Jones, DDS
• Samantha Kay Kizzire, APRN

• Family Medicine Physician in Osmond, NE
• Providers in Osmond, NE by specialty
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.