Individual provider Active NPI

Eric Robert Wildauer, D.O

  • Anesthesiology Physician
  • Erie, PA
National Provider Identifier
1114289600
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
OS018299 Issued in PA
Practice address
201 State Street
Hamot Medical Center
Erie, PA 16550
Phone
(814) 877-6000
NPI assigned
Jun 12, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OS018299 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

201 State Street
Hamot Medical Center
Erie, PA 16550

Mailing address

11781 Lee Jackson Memorial Hwy
Suite 550
Fairfax, VA 22033-3309
Phone (571) 777-5102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160824002324 PA Practitioner - Anesthesiology 9234431685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia, Pennsylvania , LLCGroup PAC ID 7517960834, 302 clinicians

Practice addresses (Care Compare)

201 State St
Erie, PA 16550-0002
Phone (814) 877-6000

Hospital & facility affiliations

  • Upmc Hamot Hospital, Erie, PA, CCN 390063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS018299PAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia, Pennsylvania , LLC Anesthesiology CurrentSince Jun 25, 2016 Accepting new patients

Locations

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

201 State St
Erie, PA 16550
Phone (814) 877-2137

Interoperability endpoints

  • Direct secure messaging: ewildauer535539@upmc.direct-ci.com

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.

Hospital & facility affiliations 2

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": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1114289600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11781 LEE JACKSON MEMORIAL HWY",
            "address_2": "SUITE 550",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333309",
            "telephone_number": "571-777-5102",
            "fax_number": "703-563-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 STATE STREET",
            "address_2": "HAMOT MEDICAL CENTER",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "16550",
            "telephone_number": "814-877-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDAUER",
        "first_name": "ERIC",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "OS018299",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.