Individual provider Active NPI

John Blaine Riley III

  • Anesthesiology Physician
  • Omaha, NE
National Provider Identifier
1962067595
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
8445 Issued in NE
Practice address
984150 Nebraska Medical Ctr
Omaha, NE 68198-4150
Phone
(402) 559-7405
NPI assigned
May 9, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD215519 OR
Anesthesiology Physician 207L00000X 8445 NE Primary

Addresses

Primary practice location

984150 Nebraska Medical Ctr
Omaha, NE 68198-4150

Mailing address

984150 Nebraska Medical Ctr
Omaha, NE 68198-4150

Other practice location 1

S 42nd and Emile Street
Omaha, NE 68198-0001
Phone (402) 552-2000

Other practice location 2

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7641

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
I20241023003768 NE Practitioner - Anesthesiology 0244562015 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Nebraska College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Father Flanagans Boys HomeGroup PAC ID 9638165400, 93 clinicians

Practice addresses (Care Compare)

14000 Boys Town Hospital Rd
Boys Town, NE 68010-7513
Phone (531) 355-6000

Hospital & facility affiliations

  • Boys Town National Research Hospital Hospital, Boys Town, NE, CCN 283300

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Father Flanagan'S Boys' Home Anesthesiology CurrentSince Aug 31, 2024 Accepting new patients
ENT Services PC Past Accepting new patients

Locations

14000 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6000

14080 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6900

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1962067595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984150 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681984150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984150 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681984150",
            "telephone_number": "402-559-7405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "S 42nd and Emile Street",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681980001",
            "country_code": "US",
            "telephone_number": "402-552-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-7641",
            "fax_number": "503-494-4661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "JOHN",
        "middle_name": "BLAINE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-09",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD215519",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NE",
            "license": "8445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.