NPIMap

Individual provider Active NPI

Erika Alyse Overbeek Wager, D.O.

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1164794418
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0060136 Issued in CO
Practice address
320 E Fontanero St Ste 100
Colorado Springs, CO 80907-7535
Phone
(719) 365-7420
NPI assigned
Feb 2, 2012
Last updated
Jun 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0060136 CO Primary
General Practice Physician 208D00000X 1063 NE

Addresses

Primary practice location

320 E Fontanero St Ste 100
Colorado Springs, CO 80907-7535

Mailing address

1650 Cochrane Cir
Iron Horse Family Medicine Clinic
Fort Carson, CO 80913-4604
Phone (719) 524-4150

Other practice location 1

1650 Cochrane Cir
Iron Horse Family Medicine Clinic
Fort Carson, CO 80913
Phone (719) 524-4150

Other identifiers 1

IdentifierTypeStateIssuer
028918OtherCOKAISER COMMERCIAL NUMBER

Other names 1

  • Ms. Erika Alyse Wager Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20180730000688 CO Practitioner - Family Practice 9032330238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

320 E Fontanero St
Suite 100 Uchealth Primary Care Fontanero
Colorado Springs, CO 80907-7535
Phone (719) 365-7420

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1063NEMDPsychologist
DR.0060136COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC General Practice CurrentSince Sep 6, 2022 Accepting new patients
Poudre Valley Medical Group, LLC General Practice CurrentSince Sep 6, 2022 Accepting new patients

Locations

320 E Fontanero St
Ste 100
Colorado Springs, CO 80907
Phone (719) 327-6404

Organizations & group practices 2

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 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1164794418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR",
            "address_2": "IRON HORSE FAMILY MEDICINE CLINIC",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134604",
            "telephone_number": "719-524-4150",
            "fax_number": "719-524-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E FONTANERO ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809077535",
            "telephone_number": "719-365-7420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Cochrane Cir",
            "address_2": "Iron Horse Family Medicine Clinic",
            "address_purpose": "LOCATION",
            "city": "Fort Carson",
            "state": "CO",
            "postal_code": "80913",
            "country_code": "US",
            "telephone_number": "719-524-4150",
            "fax_number": "719-524-2258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OVERBEEK WAGER",
        "first_name": "ERIKA",
        "middle_name": "ALYSE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0060136",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NE",
            "license": "1063",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "028918",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIKA",
            "last_name": "WAGER",
            "middle_name": "ALYSE",
            "prefix": "MS.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.