NPIMap

Individual provider Active NPI

Ian Luke Engebretsen, MD

  • Family Medicine Physician
  • Omaha, NE
National Provider Identifier
1164911673
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8161 Issued in NE
Practice address
983075 Nebraska Medical Ctr
Omaha, NE 68198-3075
Phone
(402) 559-7249
NPI assigned
May 9, 2018
Last updated
May 9, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 8161 NE Primary

Addresses

Primary practice location

983075 Nebraska Medical Ctr
Omaha, NE 68198-3075

Mailing address

983075 Nebraska Medical Ctr
Omaha, NE 68198-3075
Phone (402) 559-7249

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
I20210726003064 NE Practitioner - Family PracticePractitioner - Emergency Medicine 1153673181 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faith Regional Physician Services LLCGroup PAC ID 5193786168, 194 clinicians

Practice addresses (Care Compare)

615 E 14TH St
FRPS Wayne Family Medicine
Wayne, NE 68787-1152
Phone (402) 375-2500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.77 of 100Reported as group
Quality
67.03
Promoting interoperability
96
Improvement activities
40
Cost
72.22

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Center Current Accepting new patients
Faith Regional Physician Services, LLC Family Medicine CurrentSince Aug 23, 2021 Accepting new patients
Faith Regional Physician Services, LLC CurrentSince Aug 23, 2021 Accepting new patients
Providence Medical Center CurrentSince Jul 15, 2021 Accepting new patients
Providence Medical Center CurrentSince Jul 15, 2021 Accepting new patients
Lindahl Healthcare, Inc. Past Accepting new patients

Locations

47452 268 Ave
Ste C
Humphrey, NE 68642
Phone (402) 923-0150

2600 W Norfolk Ave
Ste 200
Norfolk, NE 68701
Phone (402) 844-8194

1200 Providence Rd
Wayne, NE 68787
Phone (402) 375-3800

615 E 14th St
Wayne, NE 68787
Phone (402) 375-2500

Interoperability endpoints

  • Direct secure messaging: iengebretsen82355@direct.nebraskamed.com

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Providence Medical CenterWayne, NE, CCN 28Z345 Hospital Corporate Officer Jan 1, 2025
Providence Medical Center Home HealthWayne, NE, CCN 287095 Home health agency Corporate Officer Jan 1, 2025
Providence HospiceWayne, NE, CCN 281520 Hospice Corporate Officer Jan 1, 2025

Owned or controlled facilities with NPI records 3

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

Organizations & group practices 6

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 8

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": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1164911673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983075 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681983075",
            "telephone_number": "402-559-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983075 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681983075",
            "telephone_number": "402-559-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGEBRETSEN",
        "first_name": "IAN",
        "middle_name": "LUKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "8161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.