NPIMap

Individual provider Active NPI

Eric Douglas Wasilowski, DO

  • Emergency Medicine Physician
  • Hoboken, NJ
National Provider Identifier
1134318298
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
58.001515 Issued in OH
Practice address
122 Jackson St Apt 1a
Hoboken, NJ 07030-6084
Phone
(206) 313-0892
NPI assigned
Oct 15, 2007
Last updated
Feb 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X 02003861A IN
Emergency Medicine Physician 207P00000X 58.001515 OH Primary

Addresses

Primary practice location

122 Jackson St Apt 1a
Hoboken, NJ 07030-6084

Mailing address

122 Jackson St Apt 1a
Hoboken, NJ 07030-6084
Phone (206) 313-0892

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100729000700 IN Practitioner - Emergency Medicine 1355408022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Emergency Physicians PCGroup PAC ID 2769384213, 79 clinicians

Practice addresses (Care Compare)

2200 Randallia Dr
Fort Wayne, IN 46805-4638
Phone (260) 373-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.02 of 100Reported as group
Quality
74.88
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.38 of 100Reported as group
Quality
87.23
Promoting interoperability
100
Improvement activities
40
Cost
83.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003861AINMDEmergency Medicine Physician
58.001515OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Emergency Physicians PC Single Specialty CurrentSince Dec 1, 2021 Accepting new patients
Community Hospital of Lagrange County Inc Current Accepting new patients
Highlands Hospital and Health Center Single Specialty Past Accepting new patients
Emergency Medicine Physicians of Cook County LLC Single Specialty Past Accepting new patients
CGH Medical Center Single Specialty Past Accepting new patients

Locations

416 E Maumee St
Angola, IN 46703
Phone (260) 665-2141

1316 E 7th St
Auburn, IN 46706
Phone (260) 925-4600

1260 E State Road 205
Columbia City, IN 46725
Phone (260) 248-9000

11109 Parkview Plaza Dr
Fort Wayne, IN 46845
Phone (260) 266-2020

2200 Randallia Dr
Fort Wayne, IN 46805
Phone (260) 373-4000

2001 Stults Rd
Huntington, IN 46750
Phone (219) 355-3000

401 N Sawyer Rd
Kendallville, IN 46755
Phone (260) 347-1100

207 N Townline Rd
Lagrange, IN 46761
Phone (260) 266-5300

10 John Kissinger Dr
Wabash, IN 46992
Phone (260) 424-2195

1355 Mariners Dr
Warsaw, IN 46582
Phone (574) 267-6778

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1134318298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 JACKSON ST APT 1A",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070306084",
            "telephone_number": "206-313-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 JACKSON ST APT 1A",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070306084",
            "telephone_number": "206-313-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASILOWSKI",
        "first_name": "ERIC",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-15",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02003861A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "58.001515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

Verify at the official NPI Registry.