Active NPI
Annette L Dillon, APRN
- Nurse Practitioner
- Elkhorn, NE
National Provider Identifier
1952415341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 110382
- Practice address
- 717 N 190TH PLZ
Ste. 1100
Elkhorn, NE 68022-3913 - Phone
- (402) 815-1700
- Fax
- (402) 815-1959
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | 110382 | NE | |
| Nurse Practitioner | 363L00000X | 110382 | NE | Primary |
Addresses
Primary practice location
717 N 190TH PLZ
Ste. 1100
Elkhorn, NE 68022-3913
Mailing address
PO Box 3755
Omaha, NE 68103-0755
Phone (402) 354-2100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10026301600 | Medicaid | NE | |
| 10026480100 | Medicaid | NE | |
| 47068731799 | Medicaid | NE | |
| 1952415341 | Medicaid | IA |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110382 | NE | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Clinic Inc | Nurse Practitioner | Current | Accepting new patients |
Locations
717 N 190th Plz
Ste 1100
Elkhorn, NE 68022
Phone (402) 815-1700
825 S 169th St
Fl 3
Omaha, NE 68118
Phone (402) 354-5451
10060 Regency Cir
Omaha, NE 68114
Phone (402) 354-1405
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476662400000",
"number": "1952415341",
"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": "402-354-2155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 N 190TH PLZ",
"address_2": "STE. 1100",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680223913",
"telephone_number": "402-815-1700",
"fax_number": "402-815-1959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLON",
"first_name": "ANNETTE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2016-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "NE",
"license": "110382",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NE",
"license": "110382",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10026301600",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10026480100",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47068731799",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1952415341",
"state": "IA"
}
],
"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 Oct 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.