NEBRASKA METHODIST HOSPITAL – Emergency Medicine Physician, NPI 1689628372
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for NEBRASKA METHODIST HOSPITAL
PO BOX 2797
OMAHA, NE 681032797
Phone: (402) 354-4230
Fax: (402) 354-6171
Type: Mailing
Nebraska Methodist Hospital, 8303, Dodge Street, Omaha, Douglas County, Nebraska, 68114, United States
OMAHA, NE 681144108
Phone: (402) 354-4000
Type: Location
West Dodge Road, Omaha, Douglas County, Nebraska, 68010, United States
SUITE 216
OMAHA, NE 681143457
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-04-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-01-31 (858 days ago).
Enrollment records
3
Earliest due date
2024-01-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040116000781 | O | Clinic/Group Practice | NE | 2024-06-30 |
| O20120814000159 | O | Clinic/Group Practice | IA | 2024-03-31 |
| O20160405000984 | O | Clinic/Group Practice | IA | 2024-01-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 68103)
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