Active NPI
Calvin P Wadley, M.D., FACEP
- Emergency Medicine Physician
- Oak Park, IL
National Provider Identifier
1831116433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 036-050417
- Practice address
- 109 N Oak Park Ave Apt 2
Oak Park, IL 60301-1362 - Phone
- (708) 524-8904
- Fax
- (708) 524-8907
- NPI assigned
- Jul 17, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036-050417 | IL | Primary |
| Emergency Medicine Physician | 207P00000X | 20748 | MN | |
| Emergency Medicine Physician | 207P00000X | 200600526 | NC |
Addresses
Primary practice location
109 N Oak Park Ave Apt 2
Oak Park, IL 60301-1362
Mailing address
109 N Oak Park Ave Apt 2
Oak Park, IL 60301-1362
Phone (708) 524-8904
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036050417 | Medicaid | IL | |
| 144XN | Other | NC | BCBS OF NC |
| 5906423 | Medicaid | NC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20748 | MN | MD | Clinical Social Worker |
| 036-050417 | IL | MD | Emergency Medicine Physician |
| 200600526 | NC | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henderson Emergency Physicians, PLLC | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Henderson, NC
- NPI 1841295904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229040000000",
"number": "1831116433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 N OAK PARK AVE APT 2",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011362",
"telephone_number": "708-524-8904",
"fax_number": "708-524-8907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N OAK PARK AVE APT 2",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011362",
"telephone_number": "708-524-8904",
"fax_number": "708-524-8907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADLEY",
"first_name": "CALVIN",
"middle_name": "P",
"credential": "M.D., FACEP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2008-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036-050417",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MN",
"license": "20748",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NC",
"license": "200600526",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036050417",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "144XN",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5906423",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.