Active NPI
Diane Jordan-Wagner, M.D.
- Allergy & Immunology (Internal Medicine) Physician
- Terre Haute, IN
National Provider Identifier
1013025097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology (Internal Medicine) Physician
- License
- 01056292A
- Practice address
- 1429 N 6TH St
Terre Haute, IN 47804-1037 - Phone
- (812) 232-0564
- Fax
- (812) 235-3330
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology (Internal Medicine) Physician | 207RA0201X | 01056292A | IN | Primary |
| Allergy & Immunology (Internal Medicine) Physician | 207RA0201X | 36106006 | IL |
Addresses
Primary practice location
1429 N 6TH St
Terre Haute, IN 47804-1037
Mailing address
221 S 6TH St
Terre Haute, IN 47807-4214
Phone (812) 232-0564
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 030005377 | Other | RAILROAD MCARE PALAMETTO | |
| 200392780 | Medicaid | IN | |
| P00844293 | Other | IN | RAILROAD MEDICARE |
| 000000230225 | Other | ANTHEM | |
| 200392780Q | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36106006 | IL | MD | Allergy & Immunology (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363219200000",
"number": "1013025097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 S 6TH ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478074214",
"telephone_number": "812-232-0564",
"fax_number": "812-235-3330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1429 N 6TH ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478041037",
"telephone_number": "812-232-0564",
"fax_number": "812-235-3330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN-WAGNER",
"first_name": "DIANE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2013-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RA0201X",
"taxonomy_group": "",
"desc": "Internal Medicine, Allergy & Immunology",
"state": "IN",
"license": "01056292A",
"primary": true
},
{
"code": "207RA0201X",
"taxonomy_group": "",
"desc": "Internal Medicine, Allergy & Immunology",
"state": "IL",
"license": "36106006",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MCARE PALAMETTO",
"identifier": "030005377",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200392780",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00844293",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000230225",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200392780Q",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.