Individual provider Active NPI

Eric Wilson

  • Family Medicine Physician
  • Sacramento, CA
National Provider Identifier
1881056307
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A150741 Issued in CA
Practice address
1500 21St St
Sacramento, CA 95811-5216
Phone
(916) 443-3299
NPI assigned
Mar 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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
Family Medicine Physician 207Q00000X A150741 CA Primary

Addresses

Primary practice location

1500 21St St
Sacramento, CA 95811-5216

Mailing address

1500 21St St
Sacramento, CA 95811-5216
Phone (916) 443-3299

Other practice location 1

3883 Airway Dr Ste 202
Santa Rosa, CA 95403-1671
Phone (707) 303-3600

Other practice location 2

3569 Round Barn Cir Ste 200
Santa Rosa, CA 95403-5781
Phone (707) 583-8800

Other practice location 3

1500 21st St
Sacramento, CA 95811-5216
Phone (916) 443-3299

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191211003119 CA Practitioner - Family Practice 4284985607 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cares Community HealthGroup PAC ID 2769418151, 45 clinicians

Practice addresses (Care Compare)

1500 21St St
Sacramento, CA 95811-5216
Phone (916) 443-3299

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A150741CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cares Community Health CurrentSince Sep 27, 2019 Accepting new patients
Cares Community Health CurrentSince Sep 27, 2019 Accepting new patients
Sutter West Bay Medical Foundation Family Medicine Past Accepting new patients

Locations

1442 Ethan Way
Ste 100
Sacramento, CA 95825
Phone (916) 443-3299

1500 21st St
Sacramento, CA 95811
Phone (916) 443-3299

1442 Ethan Way
Sacramento, CA 95825
Phone (916) 443-3299

Interoperability endpoints

  • Direct secure messaging: ewilson290328@direct.ochin.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1881056307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 21ST ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115216",
            "telephone_number": "916-443-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 21ST ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115216",
            "telephone_number": "916-443-3299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3883 Airway Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954031671",
            "country_code": "US",
            "telephone_number": "707-303-3600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3569 Round Barn Cir Ste 200",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954035781",
            "country_code": "US",
            "telephone_number": "707-583-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 21st St",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958115216",
            "country_code": "US",
            "telephone_number": "916-443-3299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ERIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-23",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A150741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.