Brooke N Wagner, PAC

Key facts

NPI

1780166827

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

2274 (NE)

Practice address

2725 S 144TH St Ste 212
Omaha, NE 68144-5253

Phone

(402) 637-0800

Fax

(402) 637-0808

NPI assigned

Sep 5, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 6

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.

• Orthowest LLC Orthopaedic Surgery Physician · Omaha, NE · NPI 1275641904
  Medicare reassignment Care Compare group NPD IA · NE · PHYSICIAN ASSISTANT
• Orthowest LLC Durable Medical Equipment & Medical Supplies · Omaha, NE · NPI 1073323606
  Care Compare group NPD PHYSICIAN ASSISTANT
• BC Healthcare LLC Interventional Pain Medicine Physician · Omaha, NE · NPI 1003495359
  Medicare reassignment NE
• Orthowest LLC Durable Medical Equipment & Medical Supplies · Elkhorn, NE · NPI 1033928668
  Care Compare group
• Orthowest LLC Durable Medical Equipment & Medical Supplies · Omaha, NE · NPI 1548133697
  Care Compare group
• Orthowest LLC Durable Medical Equipment & Medical Supplies · Council Bluffs, IA · NPI 1992514517
  Care Compare group

Hospital & facility affiliations 1

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

• Nebraska Orthopaedic Hospital LLC General Acute Care Hospital · Omaha, NE · NPI 1356345318
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthowest, LLC (109 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nebraska Orthopaedic Hospital Hospital · Omaha, NE · CCN 280129

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in NE, IA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 31, 2020.

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1780166827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 S 144TH ST STE 212",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445253",
            "telephone_number": "402-637-0800",
            "fax_number": "402-637-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 S 144TH ST STE 212",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445253",
            "telephone_number": "402-637-0800",
            "fax_number": "402-637-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BROOKE",
        "middle_name": "N",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-05",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "092923",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "onclinic@orthonebraska.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2725 S 144th St Ste 212",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681445253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Omaha, NE

• Deborah Ann Wagner Humpal, RN
• Alex Wagner, PT
• Alissa Wagner
• Brandon Arnett Wagner
• Brittany Wagner
• Cassandra Wagner
• Christina Marie Wagner
• Collette E Wagner
• Dawn G Wagner, LMT, BCTMB
• Elaine Patricia Wagner

All providers in Omaha, NE · Physician Assistant in Nebraska