Provider Demographics
NPI:1497722763
Name:BRUGGEMAN, NICHOLAS B (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:BRUGGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-637-0800
Mailing Address - Fax:402-637-0808
Practice Address - Street 1:2725 S 144TH ST STE 212
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5253
Practice Address - Country:US
Practice Address - Phone:402-637-0800
Practice Address - Fax:402-637-0808
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-36083207X00000X, 207XS0106X
NE23271207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0901066OtherAMERICHOICE-2725 S 144
IA2593269Medicaid
IA39814OtherWELLMARK-ONE EDMUNDSON
NE47602554412Medicaid
NE0901067OtherAMERICHOICE-4239 FARNAM
NE47602554420Medicaid
IAP00249542OtherRAILROAD MEDICARE
IA0593269Medicaid
IA1593269Medicaid
NE07341OtherBCBSN
NEH21529Medicare UPIN
IA2593269Medicaid
NE279211Medicare PIN