Nicholas Brennan Wagner, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

17 Davis Blvd Ste 308
Tampa, FL 33606-3438

Phone

(813) 974-2201

NPI assigned

Aug 23, 2021

Last updated

May 3, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Diagnostic Radiology

Education

Mercer University School of Medicine, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Mori Bean and Brooks Inc

  dba Coastal Vein Vascular Institute

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1093782070
  Medicare reassignment NPD

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1003583642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 DAVIS BLVD STE 308",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063438",
            "telephone_number": "813-974-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 DAVIS BLVD STE 308",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063438",
            "telephone_number": "813-974-2201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 College St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312071500",
            "country_code": "US",
            "telephone_number": "478-301-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "NICHOLAS",
        "middle_name": "BRENNAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-23",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holliston Wagner, BS, MS
• Kathleen Wagner, R.N., M.S.N.
• Kayley Pace Wagner, APRN
• Lori B Wagner, D.O.
• Melanie Beth Wagner, M.S.ED., BCBA
• Michael Justin Wagoner, M.D.
• Paula Marie Wagoner, ARNP
• Ryan Colt Wagoner, M.D.
• Waseem Zechariah Wagrees, MD
• Jahid Ahmad Wahabzai, PA-C, DO

• Student in an Organized Health Care Education/Training Program in Tampa, FL
• Providers in Tampa, FL by specialty
• Student in an Organized Health Care Education/Training Program in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.