MEDICARE: DR. JASON S. PAPENFUSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	22840	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99480	OTHER	IA	WELLMARK BLUE CROSS BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	253353	OTHER		MIDLEANDS CHOICE

General Provider Information

NPI Number	:	1881784973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON S. PAPENFUSS M.D.

Provider Business Mailing Address
First Line	:	2323 S. 171 STREET
Second Line	:	#102
City	:	OMAHA
State	:	NE
Zip	:	68130
Country	:	US
Telephone Number	:	531-933-0800
Fax Number	:	531-721-2918

Provider Business Practice Location Address
First Line	:	8601 W. DODGE RD.
Second Line	:	STE #240
City	:	OMAHA
State	:	NE
Zip	:	68114-3430
Country	:	US
Telephone Number	:	402-933-0800
Fax Number	:	402-721-2918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/11/2026

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