Active NPI
Jacob Kriedermann, D.O.
- Emergency Medicine Physician
- Wauwatosa, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 3425
- Practice address
- 10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315 - Phone
- (414) 877-5350
- NPI assigned
- Mar 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 82197-21 | WI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Emergency Medicine Physician | 207P00000X | T-2975 | MS | |
| Emergency Medicine Physician | 207P00000X | 3425 | TN | Primary |
Addresses
Primary practice location
10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Mailing address
10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Phone (414) 877-5350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01150325 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Lake Erie College of Osteopathic Medicine, Erie, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-1167
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T M Carr MD PC | Emergency Medicine | Current | Accepting new patients |
| Fredericksburg Emergency Medical Alliance, Inc. | Emergency Medicine | Current | Accepting new patients |
| EMS Observation, S.C. | Emergency Medicine | Past | Accepting new patients |
Locations
7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290
3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200
1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100
101 Hospital Center Blvd
Stafford, VA 22554
Phone (540) 741-3340
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Fredericksburg, VA
- NPI 1396779153
-
- Emergency Medicine Physician
- Dyersburg, TN
- NPI 1992706097
-
- Emergency Medicine Physician
- Brentwood, TN
- NPI 1548677610
-
- Emergency Medicine Physician
- Franklin, WI
- NPI 1033858378
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Fredericksburg, VA
- NPI 1942288527
-
- Cardiovascular Disease Physician
- Fredericksburg, VA
- NPI 1013089879
Hospital
-
- General Acute Care Hospital
- Stafford, VA
- NPI 1043343304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782777600000",
"number": "1144614603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10625 W NORTH AVE STE 101B",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532262315",
"telephone_number": "414-877-5350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10625 W NORTH AVE STE 101B",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532262315",
"telephone_number": "414-877-5350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRIEDERMANN",
"first_name": "JACOB",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-23",
"last_updated": "2026-06-30",
"certification_date": "2026-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WI",
"license": "82197-21",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MS",
"license": "T-2975",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TN",
"license": "3425",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01150325",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.