Individual provider Active NPI

Eric Vickery Ernest, M.D.

  • Emergency Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1538470489
Registry record updated Jul 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
56310 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2502
Phone
(651) 254-3456
Fax
(651) 254-5216
NPI assigned
Jun 25, 2010
Last updated
Jul 12, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 56310 MN Primary
Emergency Medicine Physician 207P00000X 60301-20 WI

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2502

Mailing address

1577 Greenbrier St
Saint Paul, MN 55106-1048
Phone (402) 201-6138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, NE2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130523000101 MN Practitioner - Emergency Medicine 6103064647
I20140624001160 NE Practitioner - Emergency Medicine 6103064647 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56310MNMDEmergency Medicine Physician
60301-20WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unmc Physicians CurrentSince Mar 25, 2017 Accepting new patients

Locations

987400 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-3405

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-1010

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

Interoperability endpoints

  • Direct secure messaging: eernest22905@direct.nebraskamed.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373587200000",
    "number": "1538470489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 GREENBRIER ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551061048",
            "telephone_number": "402-201-6138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3456",
            "fax_number": "651-254-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERNEST",
        "first_name": "ERIC",
        "middle_name": "VICKERY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2013-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "56310",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "60301-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.