NPIMap

Organization Active NPI

Alegent Creighton Health

Doing business as Alegent Creighton Health West Omaha Imaging IDTF

  • Body Imaging Physician
  • Omaha, NE
National Provider Identifier
1104251628
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
ALEGENT CREIGHTON HEALTH
Doing business as
Alegent Creighton Health West Omaha Imaging IDTF
Practice address
17201 Wright St Ste 100
Omaha, NE 68130-2042
Phone
(402) 717-4760
NPI assigned
Sep 4, 2013
Last updated
Dec 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Authorized official

Name
Tim Bricker
Title
Ceo
Phone
(541) 610-8147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X NU Primary

Addresses

Primary practice location

17201 Wright St Ste 100
Omaha, NE 68130-2042

Mailing address

PO Box 772650
Chicago, IL 60677-0001
Phone (402) 717-4377

Other names 1

  • Alegent Creighton Health West Omaha Imaging IDTF Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140106000649 NE Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1850285255 Practice locations: Omaha, NE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2067162West Omaha Imaging17201 Wright Street Suite 100, Omaha, NE 68130Certificate of waiverOct 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Midlands Express Care Lav32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Member of 5

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2650 Solution Ctr
Chicago, IL 60677

Ownership & related parties

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Thayer County Health ServicesHebron, NE, CCN 281304 Hospital Operational/Managerial Control Jul 29, 2016
Memorial Community Hospital Health SystemsBlair, NE, CCN 281359 Hospital Other Apr 1, 2002
Memorial Community Hospital & Health SystemBlair, NE, CCN 28Z359 Hospital Other Apr 1, 2002
Nebraska Spine Hospital LLCOmaha, NE, CCN 280133 Hospital 5% Or Greater Direct Ownership Interest (51%) Apr 5, 2010
Thayer County Health ServicesHebron, NE, CCN 28Z304 Hospital Operational/Managerial Control Jul 29, 2016
MCH Physicians; Blair ClinicBlair, NE, CCN 283462 Rural health clinic Other Apr 1, 2002
Davenport Medical ClinicDavenport, NE, CCN 283436 Rural health clinic Operational/Managerial Control Jul 29, 2016
Hebron Medical ClinicHebron, NE, CCN 283434 Rural health clinic Operational/Managerial Control Jul 29, 2016
Deshler Medical ClinicDeshler, NE, CCN 283446 Rural health clinic Operational/Managerial Control Jul 29, 2016
Bruning Medical ClinicBruning, NE, CCN 283433 Rural health clinic Operational/Managerial Control Jul 29, 2016
Cottonwood Rural Health ClinicTekamah, NE, CCN 283404 Rural health clinic Other Apr 1, 2002
Fort Calhoun ClinicFort Calhoun, NE, CCN 288506 Rural health clinic Other Apr 1, 2002

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1104251628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772650",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770001",
            "telephone_number": "402-717-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17201 WRIGHT ST STE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302042",
            "telephone_number": "402-717-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT CREIGHTON HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "BRICKER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-610-8147"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alegent Creighton Health West Omaha Imaging IDTF",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alegent Creighton Health West Omaha Imaging IDTF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.