Individual provider Active NPI

Annette L Dillon, APRN

  • Nurse Practitioner
  • Elkhorn, NE
National Provider Identifier
1952415341
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
110382 Issued in NE
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

Updated by the provider on Oct 17, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
10026301600MedicaidNE
10026480100MedicaidNE
47068731799MedicaidNE
1952415341MedicaidIA

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
I20060116000312 NE Practitioner - Nurse Practitioner 0840214011 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
110382NEMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Clinic Inc Nurse Practitioner CurrentSince Jul 1, 2000 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

Verify at the official NPI Registry.