Michael James Wagner, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4297 Issued in AZ

Practice address

10207 E Shady Rock LN
Tucson, AZ 85749-8162

Phone

(520) 631-2067

NPI assigned

Jan 9, 2009

Last updated

Jun 26, 2012By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of Arizona College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tucson Counseling PLLCGroup PAC ID 5991950230, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Tucson Counseling PLLC

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1740529460
  Medicare reassignment Care Compare group
• Zona Rose Healing Arts, LLC

  • Psychologist
  • Tucson, AZ
  • NPI 1801726302
  NPD Authorized official
• Tucson Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tucson, AZ
  • NPI 1285473249
  NPD

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1013154293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10207 E SHADY ROCK LN",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857498162",
            "telephone_number": "520-631-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10207 E SHADY ROCK LN",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857498162",
            "telephone_number": "520-631-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-09",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0119031",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "4297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78558",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Wagner, LCSW
• Eric Wagner
• Erica Rhea Wagner, LCSW
• Gary Wagner
• Ken Wagner
• Ray Wagner, MD
• Richard A Wagner, M.D
• Steven Wagner, LCSW
• Susan Wagner, L.AC..
• William Glyn Wagnon, MD

• Psychologist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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.