Eric Wayne Anderson, MD
Individual provider Active NPI Plastic Surgery Physician · Northfield, IL
NPI 1609260660 · NPPES record last updated Aug 29, 2023
Key facts
- NPI
- 1609260660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- 036.164924 (IL)
- Practice address
- 330 W Frontage Rd
Northfield, IL 60093-3467 - Phone
- (847) 441-4441
- NPI assigned
- Mar 26, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230922000377 | IL | Practitioner - Plastic and Reconstructive Surgery | 2062791676 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.164924 | IL | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transformations Clinical Entity Florida Illinois and Ohio SC | Plastic Surgery | Current |
Accepting new patients |
Locations
5995 Spring Creek Rd
Rockford, IL 61114
Phone (815) 654-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 036.164924 | IL | Yes |
| Plastic Surgery Physician | 208200000X | 11725384-1205 | UT |
Addresses
Primary practice location
330 W Frontage Rd
Northfield, IL 60093-3467
Mailing address
330 W Frontage Rd
Northfield, IL 60093-3467
Phone (847) 441-4441
Other providers in Northfield, IL
- John R Allemand
- Allium Counseling PC
- Max John Anthony Alvizu
- Amanda Labonar LCPC PLLC
- Ambay Health Network
- Jordan Allen Anderson
- Mary Angelopoulos
- Lauren E Anker
- Anthony J. Geroulis, MD., S.C
- Robert J. Auger
All providers in Northfield, IL · Plastic Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.