NPIMap

Individual provider Active NPI

William P Fitzgibbons, M.D.

  • Family Medicine Physician
  • Elkhorn, NE
National Provider Identifier
1265405617
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15830 Issued in NE
Practice address
1908 N 203Rd St
Elkhorn, NE 68022-2889
Phone
(402) 289-4031
Fax
(402) 289-3185
NPI assigned
Feb 8, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 15830 NE Primary

Addresses

Primary practice location

1908 N 203Rd St
Elkhorn, NE 68022-2889

Mailing address

1908 N 203Rd St Ste 2
Elkhorn, NE 68022-2889
Phone (402) 289-4031

Other identifiers 5

IdentifierTypeStateIssuer
1265405617OtherNPI
0903302OtherMEDIPASS
470710146OtherTAX I D
15830OtherNELICENSE
470710146-13MedicaidNE

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
I20100618000030 NE Practitioner - Family Practice 0244318160 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Skyline Medical Center, P.C.Group PAC ID 9335227248, 3 clinicians

Practice addresses (Care Compare)

1908 N 203Rd St
Suite 2
Elkhorn, NE 68022-2889
Phone (402) 289-4031

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.19 of 100Reported as apm
Quality
88.38
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions17
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00000NEMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: williamfitzgibbonsmd@sky.azalea.phimailbox.com

Organizations & group practices 1

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 10

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265405617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 N 203RD ST STE 2",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680222889",
            "telephone_number": "402-289-4031",
            "fax_number": "402-289-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 N 203RD ST",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680222889",
            "telephone_number": "402-289-4031",
            "fax_number": "402-289-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGIBBONS",
        "first_name": "WILLIAM",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "15830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1265405617",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIPASS",
            "identifier": "0903302",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX I D",
            "identifier": "470710146",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "15830",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470710146-13",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhorn, NE

Sources for this page

Verify at the official NPI Registry.