Active NPI
Eric Wideburg, D.O.
- Diagnostic Radiology Physician
- Waukesha, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 72422-21
- Practice address
- W231N1440 Corporate CT
Waukesha, WI 53186-1303 - Phone
- (262) 896-6000
- NPI assigned
- Mar 23, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 72422-21 | WI | Primary |
Addresses
Primary practice location
W231N1440 Corporate CT
Waukesha, WI 53186-1303
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other practice location 1
8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Phone (414) 955-4575
Other practice location 2
10945 N Port Washington Rd Ste 201
Thiensville, WI 53092-5078
Phone (262) 292-3151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100096055 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ewideburg179566@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Des Moines University of Osteopathic Medicine and Health Sciences, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589
3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100
W231 N1440 Corporate Court
Waukesha, WI 53186-1303
Phone (262) 896-6070
Hospital & facility affiliations
- Aurora St Lukes Medical Center
- Aurora Medical Center
- Aurora Medical Center Kenosha
- West Allis Memorial Hospital
- Aurora Medical Center - Summit
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72422-21 | WI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Advanced Healthcare Inc | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Diagnostic Radiology | Current | Accepting new patients |
| Premier Radiology Wisconsin, LLC | Diagnostic Radiology | Current | Accepting new patients |
| Lakeshore Medical Clinic, LLC | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Current | Accepting new patients | |
| Precision Radiology - Illinois LTD | Current | Accepting new patients | |
| Aurora Advanced Healthcare, Inc. | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Current | Accepting new patients | |
| Wisconsin Radiology Specialists, S C | Current | Accepting new patients |
Locations
2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240
100 N River Rd
Des Plaines, IL 60016
Phone (847) 297-1800
3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100
12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200
2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
10180 Washington Ave
Mount Pleasant, WI 53177
Phone (414) 769-4040
S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747
2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880
10945 N Port Washington Rd
Ste 201
Thiensville, WI 53092
Phone (262) 478-0301
13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300
W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000
Organizations & group practices 9
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.
-
- Family Medicine Physician
- Milwaukee, WI
- NPI 1265629133
-
- Certified Registered Nurse Anesthetist
- Milwaukee, WI
- NPI 1427271378
Diagnostic Radiology
-
- Family Medicine Physician
- Saint Francis, WI
- NPI 1003861188
-
- Diagnostic Radiology Physician
- Mount Pleasant, WI
- NPI 1952951154
-
- Specialist
- Mequon, WI
- NPI 1568446003
-
- Durable Medical Equipment & Medical Supplies
- Summit, WI
- NPI 1477186633
-
- Durable Medical Equipment & Medical Supplies
- Oshkosh, WI
- NPI 1326858044
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Milwaukee, WI
- NPI 1659599157
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Cudahy, WI
- NPI 1235355983
Hospital
-
- General Acute Care Hospital
- Milwaukee, WI
- NPI 1861447179
-
- General Acute Care Hospital
- Kenosha, WI
- NPI 1225156888
-
- General Acute Care Hospital
- Summit, WI
- NPI 1699008029
-
- General Acute Care Hospital
- Grafton, WI
- NPI 1265740195
-
- General Acute Care Hospital
- West Allis, WI
- NPI 1407801640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1679004469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735044",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606735044",
"telephone_number": "800-326-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W231N1440 CORPORATE CT",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531861303",
"telephone_number": "262-896-6000"
}
],
"practiceLocations": [
{
"address_1": "8701 W Watertown Plank Rd",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532263548",
"country_code": "US",
"telephone_number": "414-955-4575",
"fax_number": "414-955-6528",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10945 N Port Washington Rd Ste 201",
"address_purpose": "LOCATION",
"city": "Thiensville",
"state": "WI",
"postal_code": "530925078",
"country_code": "US",
"telephone_number": "262-292-3151",
"fax_number": "262-643-4707",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIDEBURG",
"first_name": "ERIC",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-23",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WI",
"license": "72422-21",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100096055",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ewideburg179566@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "W231N1440 Corporate Ct",
"city": "Waukesha",
"state": "WI",
"country_code": "US",
"postal_code": "531861303",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "W231N1440 Corporate Ct",
"city": "Waukesha",
"state": "WI",
"country_code": "US",
"postal_code": "531861303",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.