Active NPI
Frederick Joseph Wagner Jr., OD
- Optometrist
- Carlisle, MA
National Provider Identifier
1013052257
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jul 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2408
- Practice address
- 101 Kimball Rd
Carlisle, MA 01741 - Phone
- (978) 371-2337
- Fax
- (978) 371-2297
- NPI assigned
- Feb 21, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2408 | MA | Primary |
Addresses
Primary practice location
101 Kimball Rd
Carlisle, MA 01741
Mailing address
101 Kimball Rd
Carlisle, MA 01741
Phone (978) 371-2337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0320668 | Medicaid | MA |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2408 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013052257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 KIMBALL RD",
"city": "CARLISLE",
"state": "MA",
"postal_code": "01741",
"telephone_number": "978-371-2337",
"fax_number": "978-371-2297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 KIMBALL RD",
"city": "CARLISLE",
"state": "MA",
"postal_code": "01741",
"telephone_number": "978-371-2337",
"fax_number": "978-371-2297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "FREDERICK",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "2408",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0320668",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carlisle, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.