Individual provider Active NPI

Erik Matthews Wickstrum, CRNA

  • Certified Registered Nurse Anesthetist
  • Pueblo, CO
National Provider Identifier
1467083881
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
6797 Issued in NC
Practice address
400 W 16TH St
Pueblo, CO 81003-2781
Phone
(719) 584-4000
NPI assigned
Feb 4, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X C-APN.0001896-C-CRNA CO
Certified Registered Nurse Anesthetist 367500000X 6797 NC Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2781

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 713-0947

Other practice location 1

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-3245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200316000866 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002244555
I20220405000529 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002244555 Reassigns benefits to 16 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
May accept Medicare assignment
Group practices
The Presbyterian HospitalGroup PAC ID 1153231907, 412 clinicians

Practice addresses (Care Compare)

1500 Matthews Township Pkwy
Matthews, NC 28105-4656
Phone (704) 384-6500

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-9073

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
C-APN.0001896-C-CRNACOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Rowan Medical Center LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Novant Health Kernersville Outpatient Surgery LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
The Presbyterian Hospital CurrentSince Jan 12, 2023 Accepting new patients
Medical Park Hospital LLC CurrentSince Jan 12, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Pueblo Pathology Group, PC Current Accepting new patients
Brunswick Community Hospital, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Novant Health Thomasville Medical Center, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Presbyterian Sameday Surgery Center at Huntersville LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Novant Health Kernersville Outpatient Surgery LLC Current Accepting new patients
Novant Health Clemmons Outpatient Surgery, LLC Current Accepting new patients
Novant Health Mint Hill Medical Center, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Novant Health Ballantyne Medical Center LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2023 Accepting new patients
American Anesthesiology of North Carolina, PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 25, 2022 Accepting new patients
American Anesthesiology of North Carolina, PLLC CurrentSince Mar 25, 2022 Accepting new patients
Medical Park Hospital LLC CurrentSince Jan 12, 2023 Accepting new patients
Novant Health Matthews Medical Center LLC CurrentSince Jan 12, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 12, 2023 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Jul 1, 2022 Accepting new patients
Presbyterian Sameday Surgery Center at Ballantyne LLC Current Accepting new patients
Novant Health Rowan Medical Center, LLC CurrentSince Jan 12, 2023 Accepting new patients
The Presbyterian Hospital CurrentSince Jan 12, 2023 Accepting new patients
Presbyterian Sameday Surgery Center at Ballantyne LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
The Presbyterian Hospital Current Accepting new patients
NMG Southpark Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 28, 2023 Accepting new patients
Novant Health Clemmons Outpatient Surgery, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2023 Accepting new patients
Presbyterian Sameday Surgery Center at Huntersville LLC Current Accepting new patients
Novant Health Thomasville Medical Center LLC CurrentSince Jan 12, 2023 Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

240 Hospital Dr NE
Bolivia, NC 28422
Phone (336) 399-7678

8201 Healthcare Loop
Charlotte, NC 28215
Phone (980) 302-1000

14215 Ballantyne Corporate Pl
Ste 210
Charlotte, NC 28277
Phone (704) 316-2650

10905 Providence Rd W
Charlotte, NC 28277
Phone (980) 488-4000

6035 Fairview Rd
Charlotte, NC 28210
Phone (336) 718-2078

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

7210 Village Medical Cir
Ste 235
Clemmons, NC 27012
Phone (336) 893-3100

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

10030 Gilead Rd
Huntersville, NC 28078
Phone (704) 316-4000

1730 Kernersville Medical Pkwy
Ste 304
Kernersville, NC 27284
Phone (336) 515-7000

1500 Matthews Township Pkwy
Matthews, NC 28105
Phone (704) 384-6500

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

13 Medical Campus Dr NW
#101
Supply, NC 28462
Phone (910) 721-4300

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Organizations & group practices 29

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.

View all 29

Hospital & facility affiliations 5

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": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1467083881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-713-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-584-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-3245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKSTRUM",
        "first_name": "ERIK",
        "middle_name": "MATTHEWS",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-04",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "C-APN.0001896-C-CRNA",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "6797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.