Individual provider Active NPI

Katie Ann-Weatherl Fossen, M.D.

  • Obstetrics & Gynecology Physician
  • Lincoln, NE
National Provider Identifier
1376741264
Registry record updated Jul 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
26366 Issued in NE
Practice address
1500 S 48TH St
Suite 508
Lincoln, NE 68506-1276
Phone
(402) 483-2886
Fax
(402) 489-9684
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 26366 NE Primary

Addresses

Primary practice location

1500 S 48TH St
Suite 508
Lincoln, NE 68506-1276

Mailing address

1500 S 48TH St
Suite 508
Lincoln, NE 68506-1276
Phone (402) 483-2886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110913000852 NE Practitioner - Obstetrics/Gynecology 4486825908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Creighton University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gynecology and Fertility, P.C.Group PAC ID 6608866264, 6 clinicians

Practice addresses (Care Compare)

1500 S 48TH St
Suite 508
Lincoln, NE 68506-1279
Phone (402) 483-2886

Hospital & facility affiliations

  • Bryan Medical Center Hospital, Lincoln, NE, CCN 280003

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26366NEMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gynecology & Fertility, P.C. CurrentSince Aug 17, 2011 Accepting new patients
Bryan Medical Center Past Accepting new patients

Locations

1500 S 48th St
Ste 508
Lincoln, NE 68506
Phone (402) 483-2886

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.

Hospital & facility affiliations 3

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": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1376741264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S 48TH ST",
            "address_2": "SUITE 508",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061276",
            "telephone_number": "402-483-2886",
            "fax_number": "402-489-9684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S 48TH ST",
            "address_2": "SUITE 508",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061276",
            "telephone_number": "402-483-2886",
            "fax_number": "402-489-9684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSSEN",
        "first_name": "KATIE",
        "middle_name": "ANN-WEATHERL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NE",
            "license": "26366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.