Individual provider Active NPI

Jacob Kriedermann, D.O.

  • Emergency Medicine Physician
  • Wauwatosa, WI
National Provider Identifier
1144614603
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
3425 Issued in TN
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

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
01150325MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180926003811 TN Practitioner - Emergency Medicine 1951617588 Reassigns benefits to 2 organizations
I20240909000812 VA Practitioner - Emergency Medicine 1951617588 Reassigns benefits to 1 organization

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
Fredericksburg Emergency Medical Alliance, Inc.Group PAC ID 2163412636, 47 clinicians

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

OrganizationSpecialtyStatusNew patients
T M Carr MD PC Emergency Medicine CurrentSince Jul 2, 2023 Accepting new patients
Fredericksburg Emergency Medical Alliance, Inc. Emergency Medicine CurrentSince Jun 5, 2024 Accepting new patients
EMS Observation, S.C. Emergency Medicine PastSince Jun 5, 2022 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.

Hospital & facility affiliations 4

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": "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

Verify at the official NPI Registry.