David J Eberdt, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

424 Issued in WI

Practice address

160 Valley Dr
Lodi, WI 53555-1464

Phone

(608) 592-3296

NPI assigned

Feb 22, 2006

Last updated

Mar 24, 2021By the provider in NPPES

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: david.eberdt@direct.saukprairiehealthcare.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Sauk Prairie Healthcare Inc

  • General Acute Care Hospital
  • Prairie Du Sac, WI
  • NPI 1861466153
  Medicare reassignment
• Sauk Prairie Healthcare Inc

  • Family Medicine Physician
  • Plain, WI
  • NPI 1134194004
  NPD
• Sauk Prairie Healthcare, Inc.

  dba Prairie Clinic

  • Family Medicine Physician
  • Sauk City, WI
  • NPI 1235163494
  NPD

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1346215241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 VALLEY DR",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551464",
            "telephone_number": "608-592-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 VALLEY DR",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551464",
            "telephone_number": "608-592-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERDT",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42911700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "saukprairie@directclinics.saukprairiehealthcare.org",
            "affiliation": "N",
            "address_1": "160 Valley Dr",
            "city": "Lodi",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535551464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas F Burlage, DC
• Andrea M Chao, MD
• Joel Robert Cooper, D.C.
• Joel Patrick Crane, DDS
• Divine Rehabilitation and Nursing at Lodi LLC
• Dale P Fanney, MD
• Melissa Faubert, D.O.
• Daryn Joseph Flentje, RN
• Jean Elizabeth Gates, OTR
• Cassandra Lea Haak, APRN

• Physician Assistant in Lodi, WI
• Providers in Lodi, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; 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.

Verify at the official NPI Registry.