Provider Demographics
NPI:1033128251
Name:GANESAN, JAYANTHI (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:
Last Name:GANESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:ATTN: HOSPITAL MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-398-6255
Practice Address - Fax:402-829-8513
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22567207R00000X, 208M00000X
IAMD-37779208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025027500Medicaid
NE02731OtherBCBSN - 4242 FARNAM ST.
NE10025027500Medicaid
NE277063Medicare ID - Type Unspecified
NE10025027500Medicaid