NPIMap

Organization Active NPI

Wellnessone of Lincoln, Inc.

  • Chiropractor
  • Lincoln, NE
National Provider Identifier
1609087675
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1553 Issued in NE
Legal business name
WELLNESSONE OF LINCOLN, INC.
Practice address
4210 Pioneer Woods Dr.
Ste B
Lincoln, NE 68506-7550
Phone
(402) 484-0200
Fax
(402) 484-5677
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Authorized official

Name
Amy L Porter
Title
Cfo
Phone
(402) 420-5303

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1553 NE Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 968 NE

Addresses

Primary practice location

4210 Pioneer Woods Dr.
Ste B
Lincoln, NE 68506-7550

Mailing address

4210 Pioneer Woods Dr.
Ste B
Lincoln, NE 68506-7550
Phone (402) 484-0200

Other identifiers 2

IdentifierTypeStateIssuer
10025154200MedicaidNE
09751OtherNEBLUE CROSS BLUE SHIELD NE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041209000141 NE Part B Supplier - Clinic/Group Practice 7719943992 Receives reassigned benefits from 1 practitioner
Practice locations: Lincoln, NE

National Provider Directory

National Provider Directory

Locations

2621 S 70th St
Ste A
Lincoln, NE 68506
Phone (402) 484-0200

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1609087675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 PIONEER WOODS DR.",
            "address_2": "STE B",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067550",
            "telephone_number": "402-484-0200",
            "fax_number": "402-484-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 PIONEER WOODS DR.",
            "address_2": "STE B",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067550",
            "telephone_number": "402-484-0200",
            "fax_number": "402-484-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESSONE OF LINCOLN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "402-420-5303"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1553",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "968",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025154200",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NE",
            "identifier": "09751",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.