Individual provider Active NPI

David A. Wisthuff, PA-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1891295697
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2213 Issued in NE
Practice address
8303 Dodge St
Omaha, NE 68114-4108
Phone
(402) 354-2360
Fax
(402) 354-2440
NPI assigned
Feb 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2213 NE Primary

Addresses

Primary practice location

8303 Dodge St
Omaha, NE 68114-4108

Mailing address

PO Box 3755
Omaha, NE 68103-0755
Phone (402) 354-2100

Other identifiers 2

IdentifierTypeStateIssuer
1891295697MedicaidIA
47068731716MedicaidNE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180305001020 NE Practitioner - Physician Assistant 7214298413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

10060 Regency Cir
Omaha, NE 68114-3732
Phone (402) 354-1570

8303 Dodge St
Omaha, NE 68114-4108
Phone (402) 354-8163

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2213NEMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Nebraska Methodist Hospital Physician Assistant CurrentSince Jun 24, 2019 Accepting new patients
Physicians Clinic Inc Physician Assistant CurrentSince Apr 16, 2018 Accepting new patients

Locations

8303 W Dodge Rd
Omaha, NE 68114
Phone (402) 354-4000

10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

8303 Dodge St
Ste LL6
Omaha, NE 68114
Phone (402) 354-4104

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.

Hospital & facility affiliations 1

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": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1891295697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3755",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681030755",
            "telephone_number": "402-354-2100",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 DODGE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144108",
            "telephone_number": "402-354-2360",
            "fax_number": "402-354-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISTHUFF",
        "first_name": "DAVID",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-19",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "2213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891295697",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731716",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.