NPIMap

Organization Active NPI

MD West One, PC

  • Durable Medical Equipment & Medical Supplies
  • Council Bluffs, IA
National Provider Identifier
1164049490
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MD WEST ONE, PC
Practice address
1 Edmundson PL Ste 200
Council Bluffs, IA 51503-4658
Phone
(402) 390-4111
Fax
(402) 390-4115
NPI assigned
Jul 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Stacie Church
Title
Cfo/Business Manager
Phone
(402) 398-9243

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1 Edmundson PL Ste 200
Council Bluffs, IA 51503-4658

Mailing address

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426
Phone (402) 390-4111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200825002061 IA DME Supplier - Multi-Specialty - Physician 0446228852 Practice locations: Council Bluffs, IA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Julie R Walsh PA9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1 Edmundson Pl
Ste 200
Council Bluffs, IA 51503
Phone (712) 243-3250

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1164049490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8005 FARNAM DR STE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143426",
            "telephone_number": "402-390-4111",
            "fax_number": "402-399-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EDMUNDSON PL STE 200",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034658",
            "telephone_number": "402-390-4111",
            "fax_number": "402-390-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD WEST ONE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-02",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "STACIE",
        "authorized_official_title_or_position": "CFO/BUSINESS MANAGER",
        "authorized_official_telephone_number": "402-398-9243"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.