NPIMap

Individual provider Active NPI

Eric Thomas Walchak, D.O.

  • Cardiovascular Disease Physician
  • Wyoming, MI
National Provider Identifier
1962493395
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
5101013546 Issued in MI
Practice address
2122 Health Dr SW
Wyoming, MI 49519-9698
Phone
(616) 252-5950
Fax
(616) 252-5956
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 5101013546 MI Primary

Addresses

Primary practice location

2122 Health Dr SW
Wyoming, MI 49519-9698

Mailing address

985 Gezon Pkwy SW
Attn: Teresa McNally
Wyoming, MI 49509-9563
Phone (616) 252-4655

Other identifiers 4

IdentifierTypeStateIssuer
4618795MedicaidMI
5101013546OtherMISTATE LICENSE
EW013546OtherMIBCBSM PIN
P00145080OtherMIRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040901000595 MI Practitioner - Cardiovascular Disease (Cardiology) 9436130234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Michigan State University College of Human Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

2122 Health Dr SW
Suite 133
Wyoming, MI 49519-9698
Phone (616) 252-5950

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101013546MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Computer Health Services PC Cardiovascular Disease PastSince Mar 1, 2000 Accepting new patients
Care Group LLC Cardiovascular Disease Past Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital Past Accepting new patients
West Michigan Heart Cardiovascular Disease Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ewalchak2307@direct.metrohealth.net

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1962493395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 GEZON PKWY SW",
            "address_2": "ATTN: TERESA MCNALLY",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099563",
            "telephone_number": "616-252-4655",
            "fax_number": "616-252-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 HEALTH DR SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199698",
            "telephone_number": "616-252-5950",
            "fax_number": "616-252-5956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALCHAK",
        "first_name": "ERIC",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "5101013546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4618795",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5101013546",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "EW013546",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00145080",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.