Individual provider Active NPI

Timothy James Widhalm, M.D.

  • Family Medicine Physician
  • Aurora, NE
National Provider Identifier
1437167038
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18331 Issued in NE
Practice address
609 O St
Aurora, NE 68818-1100
Phone
(402) 694-3191
Fax
(402) 694-2146
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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 18331 NE Primary

Addresses

Primary practice location

609 O St
Aurora, NE 68818-1100

Mailing address

609 O St
Aurora, NE 68818-1100
Phone (402) 694-3191

Other identifiers 1

IdentifierTypeStateIssuer
0117OtherNEBCBS NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address TIMOTHYWIDHALM@mchi.cernerdirect.com Direct

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
I20100830000725 NE Practitioner - Family Practice 4183748098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

13315 W Ctr Rd
Omaha, NE 68137-3449
Phone (402) 717-9400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18331NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic Family Medicine CurrentSince Dec 20, 2022 Accepting new patients
Alegent Creighton Clinic Family Medicine PastSince Dec 20, 2022 Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

13315 W Center Rd
Omaha, NE 68144
Phone (402) 717-9400

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

13315 W Center Rd
Ste 100
Omaha, NE 68144
Phone (402) 717-9400

Interoperability endpoints

  • Direct secure messaging: timothywidhalm@mchi.cernerdirect.com
  • Direct secure messaging: twidhalm768740@achce.catholichealth.net

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 5

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1437167038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181100",
            "telephone_number": "402-694-3191",
            "fax_number": "402-694-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181100",
            "telephone_number": "402-694-3191",
            "fax_number": "402-694-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDHALM",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "18331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "0117",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TIMOTHYWIDHALM@mchi.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Memorial Community Health Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "609 O St",
            "city": "Aurora",
            "state": "NE",
            "country_code": "US",
            "postal_code": "688181100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, NE

Sources for this page

Verify at the official NPI Registry.