Frederick Wickwire, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

28115235A Issued in IN

Practice address

7150 Clearvista Drive
Indianapolis, IN 46256-1695

Phone

(317) 621-5890

Fax

(317) 355-2205

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516752000000",
    "number": "1265414965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9834 NORTHWIND DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462569343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 CLEARVISTA DRIVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561695",
            "telephone_number": "317-621-5890",
            "fax_number": "317-355-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKWIRE",
        "first_name": "FREDERICK",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2018-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28115235A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000108959",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100358680",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Wicks, LCSW
• Wickshire Fort Harrison Opco LLC
• Elizabeth Ann Wickstrom, M.D.
• Skyler Wickstrom
• Jennifer Nicole Wickware, RD, CD
• Wicz LLC
• Krystal Althea Renner Widau, D.O.
• Barry Craig Widdicombe, D.D.S.
• Dorota Widelka
• Meghan Elizabeth Widrig, NP

• Certified Registered Nurse Anesthetist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.