Individual provider Active NPI

Timothy A. Conner, M.D.

  • Diagnostic Radiology Physician
  • Omaha, NE
National Provider Identifier
1750385357
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
15891 Issued in WV
Practice address
17310 Wright St Ste 103
Omaha, NE 68130-2405
Phone
(833) 228-6889
Fax
(877) 853-0376
NPI assigned
Jun 10, 2005
Last updated
Oct 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X V6434 TX
Diagnostic Radiology Physician 2085R0202X 2018035939 MO
Diagnostic Radiology Physician 2085R0202X 15891 WV Primary
Diagnostic Radiology Physician 2085R0202X MTL-2023-028 GU
Diagnostic Radiology Physician 2085R0202X 15495 ND
Diagnostic Radiology Physician 2085R0202X MC-198 GU
Diagnostic Radiology Physician 2085R0202X ME139826 FL
Diagnostic Radiology Physician 2085R0202X 11756C WY
Diagnostic Radiology Physician 2085R0202X G194370 CA

Addresses

Primary practice location

17310 Wright St Ste 103
Omaha, NE 68130-2405

Mailing address

1010 N 102ND St Ste 201
Omaha, NE 68114-2122
Phone (833) 228-6889

Other practice location 1

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5000

Other practice location 2

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 857-5000

Other practice location 3

6000 Hospital Drive
Radiology
Hannibal, MO 63401
Phone (573) 248-5301

Other identifiers 13

IdentifierTypeStateIssuer
14175MedicaidWV
0119966000MedicaidWV
F23457OtherWVBRICKSTREET INSURANCE
0130753OtherWVUMWA
151237200OtherWVUS DOL & US POSTAL COMP
14193OtherWVCARELINK & CARELINK PEIA
55-0516458OtherWVGROUP FEIN #
550516458OtherWVACORDIA NATIONAL PEIA
020011800OtherWVFEDERAL BLACK LUNG
2047190MedicaidOH
550516458MedicaidWV
64942105MedicaidKY
000034924OtherWVFREEDOM BLUE & MS BCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, TX, WA, MN, WI, TN, IA, MA, ND, WY, MO, GU, CT, IL, SD, SC, NC, CA, NE19 enrollments
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 19

Enrollment IDStateProvider typePAC IDDetails
I20040304000703 WV Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 12 organizations
I20190501001441 TX Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 5 organizations
I20190611001380 WA Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20190717000091 MN Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20190918001288 WI Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20200131002804 TN Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 23 organizations
I20200527002154 IA Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20200928001370 MA Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 5 organizations
I20220209001283 ND Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20221010001100 WY Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20230628003723 MO Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20230927003762 GU Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 3 organizations
I20240513000529 CT Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20240531003562 IL Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20240620001038 SD Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20250107001968 SC Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 2 organizations
I20250109000003 NC Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 3 organizations
I20251104003326 CA Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization
I20251125001070 NE Practitioner - Diagnostic Radiology 6709784119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
West Virginia University School of Medicine, 1988
Medicare assignment
May accept Medicare assignment
Group practices
Lincoln Radiology Group P CGroup PAC ID 7113902586, 47 clinicians
Trinity HealthGroup PAC ID 7911816020, 292 clinicians
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians
Leconte Radiology PCGroup PAC ID 1850373705, 31 clinicians
Riverbend Medical Group IncGroup PAC ID 5698064343, 227 clinicians
Baptist Physician NetworkGroup PAC ID 0547333890, 121 clinicians
Radiologists of Cape Cod HospitalGroup PAC ID 2961872452, 18 clinicians
Avera McKennanGroup PAC ID 0345157103, 957 clinicians
McFarland Clinic PCGroup PAC ID 1254244239, 353 clinicians
Holyoke Medical Center IncGroup PAC ID 2163419383, 202 clinicians
Diagnostic Radiology PCGroup PAC ID 2264491570, 65 clinicians
Radiant Imaging IncGroup PAC ID 7113145558, 65 clinicians
Freeport Memorial HospitalGroup PAC ID 8426958232, 168 clinicians
Mahaska County HospitalGroup PAC ID 2769388677, 128 clinicians
Regional West Medical CenterGroup PAC ID 1759285885, 66 clinicians
Plains Radiology Services LLCGroup PAC ID 1850453432, 61 clinicians
Great Plains Radiology LLCGroup PAC ID 2062310899, 39 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Cheyenne Radiology GroupGroup PAC ID 1951293844, 34 clinicians
Central Kentucky Radiology PLLCGroup PAC ID 8921906983, 54 clinicians
Lima Radiological AssociatesGroup PAC ID 9931003977, 50 clinicians
Scotland Memorial Hospital, IncGroup PAC ID 0648208504, 259 clinicians
Guam Memorial HospitalGroup PAC ID 5890781694, 132 clinicians

Practice addresses (Care Compare)

Soddy Daisy, TN 37379
Phone (910) 615-4000

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5000

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6000

1105 Dale Ave
Benton City, WA 99320-8872
Phone (509) 588-4075

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

133 Route 3
Dededo, GU 96929-6911
Phone (671) 645-5500

1401 W 5TH St
Sheridan, WY 82801-2705
Phone (307) 672-1000

1600 S 48TH St
Lincoln, NE 68506-1227
Phone (402) 489-9400

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

200 Prosser Health Dr
Prosser, WA 99350-7832
Phone (509) 788-6022

266 Joule St
Alcoa, TN 37701-2422
Phone (865) 984-3864

271 Carew St
Springfield, MA 01104-2377
Phone (413) 748-9000

3080 College St
Beaumont, TX 77701-4606
Phone (409) 212-5000

35 Wilkens LN
Hyannis, MA 02601-2082
Phone (508) 862-5000

3555 Stagg Dr
Beaumont, TX 77701-4509
Phone (409) 212-5922

37868 US Hwy 18
Prairie Du Chien, WI 53821-8416
Phone (608) 357-2000

3916 Reaching Way
Soddy Daisy, TN 37379-8256
Phone (605) 322-4878

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

5 Stony Point Rd
Charleston, WV 25314-1663
Phone (307) 634-7711

500 Jefferson St
Whiteville, NC 28472-3634
Phone (910) 642-8011

500 Lauchwood Dr
Laurinburg, NC 28352-5501
Phone (856) 848-3227

575 Beech St
Holyoke, MA 01040-2223

723 Memorial St
Prosser, WA 99350-1524
Phone 50978655995599

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913-3128
Phone (671) 647-2552

907 E Lamar Alexander Pkwy
Maryville, TN 37804-5015
Phone (865) 977-5567

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G194370CAMDDiagnostic Radiology Physician
ME139826FLMDDiagnostic Radiology Physician
MC-198GUMDDiagnostic Radiology Physician
2018035939MOMDDiagnostic Radiology Physician
15495NDMDDiagnostic Radiology Physician
V6434TXMDDiagnostic Radiology Physician
15891WVMDDiagnostic Radiology Physician

Practice roles (60 of 86)

OrganizationSpecialtyStatusNew patients
Radiology Associates of Tallahassee PA Diagnostic Radiology CurrentSince Nov 1, 2020 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Apr 3, 2024 Accepting new patients
Hannibal Regional Healthcare System Inc CurrentSince Jun 1, 2023 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Sep 1, 2025 Accepting new patients
Cheyenne Radiology Group CurrentSince Apr 1, 2022 Accepting new patients
Winnebago Tribe of Nebraska CurrentSince Mar 8, 2024 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Avera McKennan Diagnostic Radiology CurrentSince Aug 4, 2024 Accepting new patients
Radiologists of Cape Cod Hospital Diagnostic Radiology CurrentSince Jan 9, 2023 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Mar 6, 2019 Accepting new patients
Trinity Health CurrentSince Feb 1, 2022 Accepting new patients
Valley Radiology P a Diagnostic Radiology CurrentSince Nov 12, 2024 Accepting new patients
Gibson Community Hospital Association CurrentSince Oct 5, 2025 Accepting new patients
East Memphis Pet Imaging, LLC Diagnostic Radiology CurrentSince Feb 1, 2021 Accepting new patients
Memphis Physicians Radiological Group PC Diagnostic Radiology CurrentSince Dec 1, 2019 Accepting new patients
NRHS Radiology Associates Diagnostic Radiology CurrentSince Mar 14, 2020 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Apr 3, 2024 Accepting new patients
Spartanburg Medical Center Diagnostic Radiology CurrentSince Dec 1, 2024 Accepting new patients
Tulsa X-Ray Laboratory PLLC Diagnostic Radiology CurrentSince Feb 5, 2019 Accepting new patients
Memorial Hospital of Sheridan County Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
The Duluth Clinic LTD CurrentSince May 6, 2019 Accepting new patients
Rosebud Indian Health Service CurrentSince Aug 31, 2024 Accepting new patients
Radiology Consultants PC Diagnostic Radiology CurrentSince Jan 1, 2022 Accepting new patients
The Duluth Clinic, LTD. CurrentSince May 6, 2019 Accepting new patients
Hegg Memorial Hospital CurrentSince Jun 1, 2020 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Riverbend Medical Group, Inc CurrentSince May 4, 2024 Accepting new patients
Columbus Regional Healthcare System CurrentSince Jul 5, 2025 Accepting new patients
Lincoln Radiology Group P C Diagnostic Radiology CurrentSince Jan 1, 2026 Accepting new patients
Winnebago Tribe of Nebraska CurrentSince Mar 8, 2024 Accepting new patients
Prosser Public Hospital District of Benton County Current Accepting new patients
Guam Healthcare Development Incorporated CurrentSince Sep 18, 2023 Accepting new patients
Allen Memorial Hospital Corporation Diagnostic Radiology CurrentSince Mar 3, 2023 Accepting new patients
Western Mass Physician Associates Inc CurrentSince Oct 1, 2024 Accepting new patients
Quantum Radiology, PC Diagnostic Radiology CurrentSince Jul 1, 2019 Accepting new patients
Guam Memorial Hospital CurrentSince Jul 17, 2024 Accepting new patients
Columbus Regional Healthcare System CurrentSince Jul 5, 2025 Accepting new patients
Guam X-Ray Diagnostic Radiology CurrentSince Sep 11, 2023 Accepting new patients
Mahaska County Hospital Family Medicine CurrentSince Jan 3, 2024 Accepting new patients
Great Plains Radiology LLC Diagnostic Radiology CurrentSince Aug 1, 2023 Accepting new patients
Radiant Imaging, Inc. Diagnostic Radiology CurrentSince Apr 1, 2024 Accepting new patients
Leconte Radiology PC Diagnostic Radiology CurrentSince Feb 20, 2019 Accepting new patients
Freeport Memorial Hospital CurrentSince May 6, 2024 Accepting new patients
Southern Radiology Associates, PLLC Diagnostic Radiology CurrentSince Feb 1, 2025 Accepting new patients
Scotland Memorial Hospital Inc CurrentSince Feb 1, 2025 Accepting new patients
Memorial Hospital of Sheridan County CurrentSince Oct 1, 2022 Accepting new patients
Diagnostic Radiology PC Diagnostic Radiology CurrentSince Sep 1, 2022 Accepting new patients
Lima Radiological Associates Diagnostic Radiology CurrentSince May 1, 2020 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince May 1, 2019 Accepting new patients
Scotland Memorial Hospital Inc Diagnostic Radiology CurrentSince Feb 1, 2025 Accepting new patients
Spartanburg Medical Center Diagnostic Radiology CurrentSince Dec 1, 2024 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Mar 6, 2019 Accepting new patients
Baptist Physician Network CurrentSince Jul 1, 2019 Accepting new patients
Madison Community Hospital CurrentSince Jul 1, 2024 Accepting new patients
Concord Radiology PLLC Diagnostic Radiology CurrentSince Apr 17, 2023 Accepting new patients
Prairie Du Chien Memorial Hospital Association Inc CurrentSince Sep 1, 2019 Accepting new patients
Hegg Memorial Hospital Family Medicine Current Accepting new patients
Trinity Health CurrentSince Feb 1, 2022 Accepting new patients
Tallahassee Diag Imaging Ctr LTD Diagnostic Radiology CurrentSince Nov 1, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Sep 1, 2025 Accepting new patients

Locations (25 of 98)

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

350 John Muir Pkwy
Ste 160
Brentwood, CA 94513
Phone (925) 204-1920

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

100 W California Blvd
Pasadena, CA 91105
Phone (626) 397-3445

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 780-0110

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

1300 Hall Blvd
Fl 3
Bloomfield, CT 06002
Phone (860) 714-2376

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

201 Chestnut Hill Rd
Stafford Springs, CT 06076
Phone (860) 265-6521

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

1600 Phillips Rd
Tallahassee, FL 32308
Phone (850) 216-3686

133 Route 3
Dededo, GU 96929
Phone (671) 645-5500

633 Gov Carlos G Camacho Rd
Ste 210
Tamuning, GU 96913
Phone (671) 649-1001

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • Direct secure messaging: tconner432794@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 89

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.

View all 89

Hospital & facility affiliations 9

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": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1750385357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N 102ND ST STE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142122",
            "telephone_number": "833-228-6889",
            "fax_number": "877-853-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17310 WRIGHT ST STE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302405",
            "telephone_number": "833-228-6889",
            "fax_number": "877-853-0376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Burdick Expy W",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587014406",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6000 Hospital Drive",
            "address_2": "Radiology",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "63401",
            "country_code": "US",
            "telephone_number": "573-248-5301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNER",
        "first_name": "TIMOTHY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "V6434",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2018035939",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WV",
            "license": "15891",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GU",
            "license": "MTL-2023-028",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "15495",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GU",
            "license": "MC-198",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME139826",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WY",
            "license": "11756C",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G194370",
            "primary": false
        }
    ],
    "identifiers": [
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            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14175",
            "state": "WV"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "0119966000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRICKSTREET INSURANCE",
            "identifier": "F23457",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "0130753",
            "state": "WV"
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        {
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            "desc": "Other (non-Medicare)",
            "issuer": "US DOL & US POSTAL COMP",
            "identifier": "151237200",
            "state": "WV"
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        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK & CARELINK PEIA",
            "identifier": "14193",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP FEIN #",
            "identifier": "55-0516458",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACORDIA NATIONAL PEIA",
            "identifier": "550516458",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "020011800",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2047190",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550516458",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64942105",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM BLUE & MS BCBS",
            "identifier": "000034924",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.