Active NPI
Kerri S Otto, PA
- Medical Physician Assistant
- Lincoln, NE
National Provider Identifier
1972601102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1020
- Practice address
- 7100 Stephanie LN Ste 100
Lincoln, NE 68516-5332 - Phone
- (402) 484-9009
- Fax
- (402) 483-4223
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dermatology Physician | 207NP0225X | 1020 | NE | |
| Procedural Dermatology Physician | 207NS0135X | 1020 | NE | |
| Medical Physician Assistant | 363AM0700X | 1020 | NE | Primary |
Addresses
Primary practice location
7100 Stephanie LN Ste 100
Lincoln, NE 68516-5332
Mailing address
PO Box 6068
Lincoln, NE 68506-0068
Phone (402) 484-9009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47065843713 | Medicaid | NE |
Other names 1
- Kerri S Peters
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1020 | NE | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Surgical Associates, LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Ophthalmology Physician
- Lincoln, NE
- NPI 1417952995
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1972601102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6068",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685060068",
"telephone_number": "402-484-9009",
"fax_number": "402-483-4223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7100 STEPHANIE LN STE 100",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685165332",
"telephone_number": "402-484-9009",
"fax_number": "402-483-4223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "KERRI",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207NP0225X",
"taxonomy_group": "",
"desc": "Dermatology, Pediatric Dermatology",
"state": "NE",
"license": "1020",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "NE",
"license": "1020",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NE",
"license": "1020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47065843713",
"state": "NE"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KERRI",
"last_name": "PETERS",
"middle_name": "S",
"credential": "PA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.