Active NPI
Jeremy Wodarek
- Student in an Organized Health Care Education/Training Program
- Richmond, VA
National Provider Identifier
1174133573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 0116041752
- Practice address
- 1001 E Leigh St
Richmond, VA 23298-5004 - Phone
- (804) 828-2676
- NPI assigned
- Jul 31, 2020
- Last updated
- Sep 22, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 0116041752 | VA | Primary |
Addresses
Primary practice location
1001 E Leigh St
Richmond, VA 23298-5004
Mailing address
PO Box 980257
Richmond, VA 23298-0257
Phone (804) 828-9783
Other practice location 1
401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-2111
Other practice location 2
1632 Stone St
Saginaw, MI 48602
Phone (989) 583-6595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210624001506 | MI | Order and Referring Only - Orthopedic Surgery | 0143621474 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790035200000",
"number": "1174133573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 980257",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232980257",
"telephone_number": "804-828-9783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 E LEIGH ST",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232985004",
"telephone_number": "804-828-2676"
}
],
"practiceLocations": [
{
"address_1": "401 S Ballenger Hwy",
"address_purpose": "LOCATION",
"city": "Flint",
"state": "MI",
"postal_code": "485323638",
"country_code": "US",
"telephone_number": "810-342-2111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1632 Stone St",
"address_purpose": "LOCATION",
"city": "Saginaw",
"state": "MI",
"postal_code": "48602",
"country_code": "US",
"telephone_number": "989-583-6595",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WODAREK",
"first_name": "JEREMY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-31",
"last_updated": "2026-09-22",
"certification_date": "2026-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "VA",
"license": "0116041752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.