Active NPI
Tanner Wiebelhaus, PT, DPT
- Physical Therapist
- Omaha, NE
National Provider Identifier
1790443869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4286
- Practice address
- 4614 S 132ND St
Omaha, NE 68137-1764 - Phone
- (402) 330-3211
- Fax
- (402) 330-5970
- NPI assigned
- Dec 6, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4286 | NE | Primary |
Addresses
Primary practice location
4614 S 132ND St
Omaha, NE 68137-1764
Mailing address
4614 S 132ND St
Omaha, NE 68137-1764
Phone (402) 330-3211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47065477701 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1260 Valley View Dr
Council Bluffs, IA 51503-5245
Phone (402) 609-3000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthowest LLC | Physical Therapist | Current | Accepting new patients |
| Orthowest LLC | Current | Accepting new patients |
Locations
933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000
2725 S 144th St
Ste 212
Omaha, NE 68144
Phone (402) 354-4000
Organizations & group practices 2
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.
-
- Durable Medical Equipment & Medical Supplies
- Omaha, NE
- NPI 1073323606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638748800000",
"number": "1790443869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4614 S 132ND ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681371764",
"telephone_number": "402-330-3211",
"fax_number": "402-330-5970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4614 S 132ND ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681371764",
"telephone_number": "402-330-3211",
"fax_number": "402-330-5970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEBELHAUS",
"first_name": "TANNER",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-06",
"last_updated": "2021-12-06",
"certification_date": "2021-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NE",
"license": "4286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47065477701",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.