Individual provider Active NPI

Eric Wandler, MD

  • Diagnostic Radiology Physician
  • Charlottesville, VA
National Provider Identifier
1144460619
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101261623 Issued in VA
Practice address
1215 Lee St FL 1
Charlottesville, VA 22908-0816
Phone
(434) 982-6018
Fax
(434) 982-1618
NPI assigned
Feb 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 237986-1 NY
Diagnostic Radiology Physician 2085R0202X 062450 GA
Diagnostic Radiology Physician 2085R0202X 0101261623 VA Primary

Addresses

Primary practice location

1215 Lee St FL 1
Charlottesville, VA 22908-0816

Mailing address

PO Box 9007
Charlottesville, VA 22906-9007

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20170830002171 GA Practitioner - Diagnostic Radiology 9537443726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

20 Glenlake Pkwy
Atlanta, GA 30328-3473
Phone (770) 677-6043

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
237986-1NYMDDiagnostic Radiology Physician
0101261623VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Diagnostic Radiology CurrentSince Aug 14, 2017 Accepting new patients

Locations

2142 W Broad St
Bldg 200
Athens, GA 30606
Phone (706) 548-6881

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2525 Cumberland Pkwy SE
Atlanta, GA 30339
Phone (770) 431-4145

6875 Douglas Blvd
Ste A
Douglasville, GA 30135
Phone (678) 838-2225

3650 Steve Reynolds Blvd
Duluth, GA 30096
Phone (770) 931-6010

2400 Mount Zion Pkwy
Jonesboro, GA 30236
Phone (770) 603-3649

750 Townpark Ln NW
Kennesaw, GA 30144
Phone (770) 514-5401

5440 Hillandale Dr
Lithonia, GA 30058
Phone (770) 322-2716

1125 Town Center Village Dr
McDonough, GA 30253
Phone (678) 583-6557

205 Newnan Crossing Byp
Newnan, GA 30265
Phone (404) 379-6148

1100 Lake Hearn Dr
Ste 250
Sandy Springs, GA 30342
Phone (404) 845-4500

20 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (770) 677-6247

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": "1235433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1144460619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229069007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 LEE ST FL 1",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-982-6018",
            "fax_number": "434-982-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDLER",
        "first_name": "ERIC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-24",
        "last_updated": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "237986-1",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "062450",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101261623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "20 Glenlake Pkwy",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303283473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.