ERIC J WATTENBURG (MD) – Emergency Medicine Physician, NPI 1194791640
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
270 EMERGENCY MEDICINE in ID
Provider Addresses for ERIC J WATTENBURG (MD)
6051 W Emerald St
Boise, ID 837048969
Phone: (208) 302-5150
Fax: (208) 302-5155
Type: Location
3818, Southwest 21st Street, Redmond, Deschutes County, Oregon, 97756, United States
REDMOND, OR 97756
Phone: (541) 548-2899
Fax: (541) 504-3781
Type: Location
PO BOX 4858
PORTLAND, OR 972084858
Phone: (541) 500-2500
Fax: (541) 500-2700
Type: Mailing
Sisters Post Office, 694, North Larch Street, Sisters, Deschutes County, Oregon, 97759, United States
SISTERS, OR 977591600
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-12-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160614001973 | I | Family Practice | CA | TBD |
| I20241202003039 | I | Family Practice | ID | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 83704)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | CA | |
| Emergency Medicine, General Practice | CA | |
| Family Practice, Emergency Medicine | CA | |
| Physician Assistant | CA | |
| Nurse Practitioner | CA | |
| P O D I A T R Y | CA | |
| Emergency Medicine | MO | |
| General Surgery | CA | |
| Orthopedic Surgery | CA | |
| - | CA |
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