Eddie J Wickline, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

28137996A Issued in IN

Practice address

2310 California Rd
Ste a
Elkhart, IN 46514-1228

Phone

(574) 264-0791

Fax

(574) 262-9650

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Medicine Center of Northern Indiana IncGroup PAC ID 0840260105, 46 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.85 of 100Reported as group

Quality

59.71

Promoting interoperability

90

Improvement activities

40

Cost

88.11

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

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.

• Orthopedic and Sports Medicine Center of Northern Indiana, Inc

  • Orthopaedic Surgery Physician
  • Elkhart, IN
  • NPI 1710085253
  Medicare reassignment Care Compare group
• ASC Surgical Ventures, LLC

  • Ambulatory Surgical Clinic/Center
  • Elkhart, IN
  • NPI 1083715148
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1891805503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 CALIFORNIA RD",
            "address_2": "STE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141228",
            "telephone_number": "574-264-0791",
            "fax_number": "574-262-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 CALIFORNIA RD",
            "address_2": "STE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141228",
            "telephone_number": "574-264-0791",
            "fax_number": "574-262-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLINE",
        "first_name": "EDDIE",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28137996A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200295510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke White, PTA
• Michelle White
• Kenneth Jordan Whiting, CRNA
• Amy Whitinger, M.ED., A.T.C, L.A.T.
• Whole Body Chiropractic LLC
• Clark Widmoyer
• Susan Widup, RPH
• Meredith Katherine Wierman Schmidt, DO
• Julie D Wilke, MSW, ACSW, LCSW
• Amy Kristine Williams, BSW

• Certified Registered Nurse Anesthetist in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.