Individual provider Active NPI

Eric R. Wiedower, DO

  • Hematology & Oncology Physician
  • Germantown, TN
National Provider Identifier
1154633857
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
3015 Issued in TN
Practice address
7945 Wolf River Blvd
Germantown, TN 38138-1733
Phone
(901) 683-0055
NPI assigned
Jul 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 3015 TN Primary
Hematology & Oncology Physician 207RH0003X 24301 MS

Addresses

Primary practice location

7945 Wolf River Blvd
Germantown, TN 38138-1733

Mailing address

7714 Poplar Ave Ste 200
Attn: Credentialing
Germantown, TN 38138-3941
Phone (901) 683-0055

Other identifiers 2

IdentifierTypeStateIssuer
08484348MedicaidMS
Q022586MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 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
I20160607001247 MS Practitioner - Hematology/Oncology 8022266725 Reassigns benefits to 1 organization
I20160616001325 TN Practitioner - Hematology/Oncology 8022266725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The West Clinic P.C.Group PAC ID 2668360579, 115 clinicians

Practice addresses (Care Compare)

1588 Union Ave
Memphis, TN 38104-3729
Phone (901) 300-1562

2001 State Dr
Corinth, MS 38834-9324
Phone (662) 286-3694

240 Grandview Dr
Brighton, TN 38011-4253
Phone (901) 475-0678

7668 Airways Blvd
Southaven, MS 38671-5304
Phone (662) 349-9556

7945 Wolf River Blvd
Germantown, TN 38138-1762
Phone (901) 683-0055

Hospital & facility affiliations

  • Homechoice Health Services - Hernando Home health agency, Hernando, MS, CCN 257034
  • Accentcare Home Health of Greenwood Home health agency, Greenwood, MS, CCN 257131
  • Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
  • St Francis Hospital Hospital, Memphis, TN, CCN 440183
  • Regional One Health Hospital, Memphis, TN, CCN 440152
  • Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167
  • Baptist Memorial Hospital North Ms Hospital, Oxford, MS, CCN 250034

Merit-based Incentive Payment System (MIPS)

Final score
90.15 of 100Reported as subgroup
Quality
83.22
Promoting interoperability
100
Improvement activities
40
Cost
77.26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24301MSMDHematology & Oncology Physician
3015TNMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The West Clinic P.C. Hematology & Oncology CurrentSince Jul 1, 2016 Accepting new patients

Locations

7668 Airways Blvd
Southaven, MS 38671
Phone (662) 349-9556

240 Grandview Dr
Brighton, TN 38011
Phone (901) 475-0678

100 N Humphreys Blvd
Memphis, TN 38120
Phone (901) 747-1800

1588 Union Ave
Memphis, TN 38104
Phone (901) 276-2410

7714 Poplar Ave
Ste 200
Memphis, TN 38138
Phone (901) 322-9080

7945 Wolf River Blvd
Memphis, TN 38138
Phone (901) 448-7000

1290 Kelley Dr
Paris, TN 38242
Phone (270) 554-0011

Interoperability endpoints

  • Direct secure messaging: ewiedower22831@direct.bmhcc.org
  • Direct secure messaging: ewiedower26049@mlh.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 7

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": "1278720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1154633857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7714 POPLAR AVE STE 200",
            "address_2": "ATTN: CREDENTIALING",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383941",
            "telephone_number": "901-683-0055",
            "fax_number": "901-922-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7945 WOLF RIVER BLVD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381733",
            "telephone_number": "901-683-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDOWER",
        "first_name": "ERIC",
        "middle_name": "R.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-10",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TN",
            "license": "3015",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MS",
            "license": "24301",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08484348",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q022586",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.