Individual provider Active NPI

Gage Patrick Rensch, MD

  • Dermatology Physician
  • Omaha, NE
National Provider Identifier
1942706650
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
34596 Issued in NE
Practice address
16910 Frances St
Omaha, NE 68130-2398
Phone
(402) 505-8777
Fax
(402) 933-7767
NPI assigned
Apr 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0406 SD
Dermatology Physician 207N00000X 34596 NE Primary

Addresses

Primary practice location

16910 Frances St
Omaha, NE 68130-2398

Mailing address

16910 Frances St
Omaha, NE 68130-1750
Phone (402) 505-8777

Other practice location 1

1400 W 22nd St
Sioux Falls, SD 57105-1554
Phone (605) 357-1386

Other practice location 2

1430 Tulane Ave
New Orleans, LA 70112-2632
Phone (504) 988-5126

Other identifiers 2

IdentifierTypeStateIssuer
490466211OtherPASSPORT
H13221442OtherNEDRIVER'S LICENSE

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
I20220629000533 NE Practitioner - Dermatology 7113276205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Nebraska College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mod Dermatology PCGroup PAC ID 9638430804, 7 clinicians

Practice addresses (Care Compare)

16910 Frances St
Omaha, NE 68130-2398
Phone (402) 505-8777

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision48
Removal of skin lesions301
Removal of skin cancer111
Removal of nail tissue1-10
Removal or shaving of skin growth72
Skin biopsy151

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34596NEMDDermatology Physician
0406SDMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Mod Dermatology PC Dermatology CurrentSince Aug 1, 2022 Accepting new patients

Locations

1106 E 18th St
Fremont, NE 68025
Phone (402) 505-8777

1810 N Bell St
Fremont, NE 68025
Phone (402) 505-7777

16910 Frances St
Omaha, NE 68130
Phone (402) 505-8777

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1942706650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16910 FRANCES ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681301750",
            "telephone_number": "402-505-8777",
            "fax_number": "402-933-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16910 FRANCES ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302398",
            "telephone_number": "402-505-8777",
            "fax_number": "402-933-7767"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051554",
            "country_code": "US",
            "telephone_number": "605-357-1386",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1430 Tulane Ave",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701122632",
            "country_code": "US",
            "telephone_number": "504-988-5126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENSCH",
        "first_name": "GAGE",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SD",
            "license": "0406",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NE",
            "license": "34596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "490466211",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "H13221442",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.