Active NPI
Jan Vennell Jensen, MD
- Ophthalmology Physician
- Kearney, NE
National Provider Identifier
1922001338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 12529
- Practice address
- 411 W. 39TH St.
Kearney, NE 68845 - Phone
- (308) 865-2760
- Fax
- (308) 865-2769
- NPI assigned
- May 31, 2005
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 12529 | NE | Primary |
Addresses
Primary practice location
411 W. 39TH St.
Kearney, NE 68845
Mailing address
411 W 39TH St
Kearney, NE 68845-2805
Phone (308) 865-2760
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47054533500 | 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 |
|---|---|---|---|
| 12529 | NE | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1922001338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 W 39TH ST",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688452805",
"telephone_number": "308-865-2760",
"fax_number": "308-865-2769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 W. 39TH ST.",
"city": "KEARNEY",
"state": "NE",
"postal_code": "68845",
"telephone_number": "308-865-2760",
"fax_number": "308-865-2769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "JAN",
"middle_name": "VENNELL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NE",
"license": "12529",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47054533500",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.