Active NPI
Willie Wilson
- Adult Companion
- Omaha, NE
National Provider Identifier
1174414296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 17773 Olive St
Omaha, NE 68136-2046 - Phone
- (402) 932-0072
- NPI assigned
- Jul 15, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
17773 Olive St
Omaha, NE 68136-2046
Mailing address
6818 Grover St Ste 200
Omaha, NE 68106-3632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Home Developmental Disabilities Services, Inc | Past | Accepting new patients | |
| Prime Home Developmental Disabilities Services, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Omaha, NE
- NPI 1326536558
-
- Developmentally Disabled Services Day Training Agency
- Omaha, NE
- NPI 1366996548
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752537600000",
"number": "1174414296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6818 GROVER ST STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681063632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17773 OLIVE ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681362046",
"telephone_number": "402-932-0072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WILLIE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-15",
"last_updated": "2025-07-15",
"certification_date": "2025-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.