NPIMap

Individual provider Active NPI

Erik Douglas Wiele, DO

  • General Practice Physician
  • Montclair, CA
National Provider Identifier
1619405875
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
20A17237 Issued in CA
Practice address
5000 San Bernardino St
Montclair, CA 91763-2326
Phone
(909) 625-5411
NPI assigned
May 31, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
General Practice Physician 208D00000X 20A17237 CA Primary

Addresses

Primary practice location

5000 San Bernardino St
Montclair, CA 91763-2326

Mailing address

5000 San Bernardino St
Montclair, CA 91763-2326
Phone (909) 625-5411

Other practice location 1

5673 Florence Ter
Oakland, CA 94611-2003
Phone (916) 300-7428

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190809000529 CA Practitioner - Family Practice 1355678673 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

100 Mission Blvd
Jackson, CA 95642-2536

200 Mission Blvd
Jackson, CA 95642-2564
Phone (916) 733-3777

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A17237CAMDGeneral Practice Physician
17237CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of California, Inc CurrentSince Jul 6, 2020 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Mar 1, 2022 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Mar 1, 2022 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

Interoperability endpoints

  • Direct secure messaging: ewiele547606@hisp.ehr.sutterhealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1619405875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 SAN BERNARDINO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632326",
            "telephone_number": "909-625-5411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SAN BERNARDINO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632326",
            "telephone_number": "909-625-5411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5673 Florence Ter",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946112003",
            "country_code": "US",
            "telephone_number": "916-300-7428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIELE",
        "first_name": "ERIK",
        "middle_name": "DOUGLAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A17237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.