Derek M Nelson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1126 Issued in NE

Practice address

810 N 22ND St
Blair, NE 68008-1128

Phone

(402) 426-2182

Fax

(402) 426-1190

NPI assigned

May 20, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Nebraska College of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Warren Memorial HospitalGroup PAC ID 0941303085, shared by 3 NPIs, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Community Hospital & Health System Hospital, Blair, NE, CCN 281359

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Memorial Community Hospital Corporation

  • Critical Access Hospital
  • Blair, NE
  • NPI 1265408819
  Medicare reassignment
• Tilden Community Hospital & Rural Health Clinic

  dba TCH Medical Clinic

  • Rural Health Clinic/Center
  • Tilden, NE
  • NPI 1558384842
  NPD (past)
• Warren Memorial Hospital

  dba Warren Memorial PRO FEES

  • Rural Acute Care Hospital
  • Friend, NE
  • NPI 1063595486
  NPD (past)
• Warren Memorial Hospital

  dba Friend Community Healthcare System

  • Rural Acute Care Hospital
  • Friend, NE
  • NPI 1841387552
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Community Hospital Corporation

  • Critical Access Hospital
  • Blair, NE
  • NPI 1265408819
  Care Compare affiliation

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1659325033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-2182",
            "fax_number": "402-426-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N 22ND ST",
            "city": "BLAIR",
            "state": "NE",
            "postal_code": "680081128",
            "telephone_number": "402-426-2182",
            "fax_number": "402-426-1190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "306 W 2nd St",
            "address_purpose": "LOCATION",
            "city": "Tilden",
            "state": "NE",
            "postal_code": "687814760",
            "country_code": "US",
            "telephone_number": "402-368-9964",
            "fax_number": "402-368-5675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 N 22nd St",
            "address_purpose": "LOCATION",
            "city": "Blair",
            "state": "NE",
            "postal_code": "680081128",
            "country_code": "US",
            "telephone_number": "402-426-1150",
            "fax_number": "402-426-1190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DEREK",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12350231",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025300500",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025355300",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "30694",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kari Sue Mullen
• Gavriel Antonio Munoz, PTA
• Nannen Physical Therapy and Personal Training
• David M Nannen, P.T.
• Suzanne M Nass, M.S., P.A.-C
• No Frills Pharmacy LLC (Health Mart Pharmacy)
• Susann Ashley O'Banion, NP
• Omaha Center for Pain and Chronic Conditions LLC (Omaha Chronic Conditions Center)
• Jennifer Opfer
• Katherine Orr, PT

• Physician Assistant in Blair, NE
• Providers in Blair, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.