NPIMap

Individual provider Active NPI

Nicole Lynn Wagner Dix, D.O.

  • Obstetrics & Gynecology Physician
  • Fremont, NE
National Provider Identifier
1093761041
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
466 Issued in NE
Practice address
700 E 29TH St
Fremont, NE 68025-2384
Phone
(402) 721-3133
Fax
(402) 941-7017
NPI assigned
May 25, 2006
Last updated
Jun 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 466 NE Primary

Addresses

Primary practice location

700 E 29TH St
Fremont, NE 68025-2384

Mailing address

825 S 169TH St FL 3
Omaha, NE 68118-9300
Phone (402) 354-4822

Other identifiers 1

IdentifierTypeStateIssuer
466OtherNEMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060630000158 NE Practitioner - Obstetrics/Gynecology 5193737500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

700 E 29TH St
Methodist Physicians Clinic Women's Center
Fremont, NE 68025-2384
Phone (402) 721-3133

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
466NEMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nebraska Methodist Hospital Current Accepting new patients
Physicians Clinic Inc Obstetrics & Gynecology CurrentSince May 3, 2020 Accepting new patients
Methodist Fremont Health Past Accepting new patients

Locations

2540 N Healthy Way
Fremont, NE 68025
Phone (402) 721-3133

2830 N Clarkson St
Fremont, NE 68025
Phone (402) 354-1200

450 E 23rd St
Fremont, NE 68025
Phone (402) 721-1610

700 E 29th St
Fremont, NE 68025
Phone (402) 721-3133

10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405

825 S 169th St
Fl 3
Omaha, NE 68118
Phone (402) 354-5451

Interoperability endpoints

  • Direct secure messaging: nicole.dix@direct.nmhs.org

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Methodist Fremont HealthFremont, NE, CCN 280077 Hospital Corporate Director Oct 1, 2018
Dunklau GardensFremont, NE, CCN 285119 Skilled nursing facility Corporate Director Oct 1, 2018
Methodist Fremont Health Home CareFremont, NE, CCN 287016 Home health agency Corporate Director Oct 1, 2018
Methodist Fremont Health HospiceFremont, NE, CCN 281511 Hospice Corporate Director Oct 1, 2018

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1093761041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 S 169TH ST FL 3",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681189300",
            "telephone_number": "402-354-4822",
            "fax_number": "402-941-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E 29TH ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252384",
            "telephone_number": "402-721-3133",
            "fax_number": "402-941-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER DIX",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NE",
            "license": "466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "466",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, NE

Sources for this page

Verify at the official NPI Registry.