Active NPI
Erik Wagner
- Physical Therapist
- Springfield, IL
National Provider Identifier
1710324298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070018116
- Practice address
- 800 E Carpenter St
Springfield, IL 62769-1000 - Phone
- (217) 544-6464
- NPI assigned
- May 24, 2013
- Last updated
- May 24, 2013
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070018116 | IL | Primary |
Addresses
Primary practice location
800 E Carpenter St
Springfield, IL 62769-1000
Mailing address
3712 Windshire Dr
Springfield, IL 62704-6718
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070018116 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369353600000",
"number": "1710324298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3712 WINDSHIRE DR",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627046718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E CARPENTER ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627691000",
"telephone_number": "217-544-6464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ERIK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-24",
"last_updated": "2013-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070018116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.