Organization Active NPI

Erie Spine & Pain Center PC

  • Pain Medicine Physician
  • Green Bay, WI
National Provider Identifier
1609742212
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
ERIE SPINE & PAIN CENTER PC
Practice address
4521 Algonquin TRL
Green Bay, WI 54313-9529
Phone
(814) 454-4599
NPI assigned
Oct 13, 2025
Organization subpart
Yes
Parent organization
ERIE SPINE & PAIN CENTER PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Authorized official

Name
Thomas J WilkinsNPI 1043231756
Title
Authorized Official
Phone
(920) 621-5674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

4521 Algonquin TRL
Green Bay, WI 54313-9529

Mailing address

4521 Algonquin TRL
Green Bay, WI 54313-9529
Phone (814) 454-4599

National Provider Directory

National Provider Directory
Part of
Erie Spine Pain Center PC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1609742212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4521 ALGONQUIN TRL",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543139529",
            "telephone_number": "814-454-4599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 ALGONQUIN TRL",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543139529",
            "telephone_number": "814-454-4599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE SPINE & PAIN CENTER PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ERIE SPINE & PAIN CENTER PC",
        "enumeration_date": "2025-10-13",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "920-621-5674"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; 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.