Elizabeth Ann Wickstrom, M.D.

Primary specialty

Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X

License

01088352A Issued in IN

Practice address

8081 Township Line Rd Ste 203
Indianapolis, IN 46260-2189

Phone

(317) 415-8100

NPI assigned

Nov 14, 2006

Last updated

Sep 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, KS2 enrollments

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 2

Specialty

Obstetrics/Gynecology

Education

University of Nebraska College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elizabeth.wickstrom.1@7598.direct.athenahealth.com
• Direct secure messaging: elizabeth.wickstrom.2@7598.direct.athenahealth.com
• Direct secure messaging: elizabeth.wickstrom@hca2.eclinicaldirectplus.com

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.

• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Hollister, MO
  • NPI 1053350454

  KS

  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  dba Mercy Clinic Family Medicine-Willow Springs

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  Medicare reassignment NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• Saint Lukes Physician Group II LLC

  dba Saint Lukes Physician Specialists LLC

  • Surgery Physician
  • Kansas City, MO
  • NPI 1750335337
  NPD (past)
• Women's Center at Brookside, LLC

  • Obstetrics & Gynecology Physician
  • Kansas City, MO
  • NPI 1871720078
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1952473118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8081 TOWNSHIP LINE RD STE 203",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8081 TOWNSHIP LINE RD STE 203",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602189",
            "telephone_number": "317-415-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 Wornall Rd",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641113220",
            "country_code": "US",
            "telephone_number": "816-932-6903",
            "fax_number": "816-932-5873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "KS",
            "license": "04-24625",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "MO",
            "license": "R7N69",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "IN",
            "license": "01088352A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ELIZABETH.WICKSTROM@hca2.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "4401 Wornall Rd",
            "city": "Kansas City",
            "state": "MO",
            "country_code": "US",
            "postal_code": "641113220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erika Wickett
• Christopher Scott Wickman, M.D
• Sarah F Wickman
• Michelle Wicks, LCSW
• Wickshire Fort Harrison Opco LLC
• Skyler Wickstrom
• Jennifer Nicole Wickware, RD, CD
• Frederick Wickwire, CRNA
• Wicz LLC (Brodowicz Family Dentistry)
• Krystal Althea Renner Widau, D.O.

• Maternal & Fetal Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Maternal & Fetal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.

Verify at the official NPI Registry.