NPIMap

Organization Active NPI

MD West One, PC

  • Durable Medical Equipment & Medical Supplies
  • Elkhorn, NE
National Provider Identifier
1740933530
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MD WEST ONE, PC
Practice address
222 N 192ND Street
Elkhorn, NE 68022-5363
Phone
(402) 390-4111
Fax
(402) 390-4115
NPI assigned
Feb 1, 2022
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Jennifer Maureen Fredricks
Title
Business Office Supervisor
Phone
(402) 361-5260

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Neurological Surgery Physician 207T00000X
Orthopaedic Surgery Physician 207X00000X

Addresses

Primary practice location

222 N 192ND Street
Elkhorn, NE 68022-5363

Mailing address

8005 Farnam Dr Ste 305
Omaha, NE 68114-3426
Phone (402) 390-4111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220607000612 NE DME Supplier - Multi-Specialty - Physician 0446228852 Practice locations: Elkhorn, NE

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Julie R Walsh PA9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Jack Foster Dr
Shenandoah, IA 51601
Phone (712) 246-7240

2206 Longo Dr
Ste 105
Bellevue, NE 68005
Phone (402) 291-3373

2510 Bellevue Medical Center Dr
Ste 145
Bellevue, NE 68123
Phone (402) 399-8550

3763 39th Ave
Ste 100
Columbus, NE 68601
Phone (402) 316-4027

575 S 70th St
Ste 435
Lincoln, NE 68510
Phone (402) 219-7454

17030 Lakeside Hills Plz
Ste 122
Omaha, NE 68130
Phone (402) 758-5330

5908 S 142nd St
Omaha, NE 68137
Phone (402) 354-1900

Practitioners & affiliated clinicians

Practitioners 86

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1740933530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8005 FARNAM DR STE 305",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143426",
            "telephone_number": "402-390-4111",
            "fax_number": "402-399-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N 192ND STREET",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680225363",
            "telephone_number": "402-390-4111",
            "fax_number": "402-390-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD WEST ONE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "FREDRICKS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MAUREEN",
        "authorized_official_title_or_position": "BUSINESS OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "402-361-5260"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhorn, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.