NPIMap

Individual provider Active NPI

Kamal C Wagle, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
National Provider Identifier
1013249838
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
25MA11879900 Issued in NJ
Practice address
360 Essex St Ste 303
Hackensack, NJ 07601-8566
Phone
(551) 996-8100
NPI assigned
Feb 3, 2010
Last updated
Apr 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01075433A IN
Family Medicine Physician 207Q00000X N9976 TX
Geriatric Medicine (Family Medicine) Physician 207QG0300X N9976 TX
Geriatric Medicine (Family Medicine) Physician 207QG0300X 01075433A IN
Geriatric Medicine (Family Medicine) Physician 207QG0300X 25MA11879900 NJ Primary

Addresses

Primary practice location

360 Essex St Ste 303
Hackensack, NJ 07601-8566

Mailing address

3600 Route 66 FL 3
Neptune, NJ 07753-2645

Other identifiers 1

IdentifierTypeStateIssuer
201291250MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150612000894 IN Practitioner - Geriatric MedicinePractitioner - Family Practice 1153585260 Reassigns benefits to 2 organizations
I20240315003665 NJ Practitioner - Geriatric MedicinePractitioner - Internal Medicine 1153585260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

360 Essex St
Suite 303
Hackensack, NJ 07601-8550
Phone (201) 710-2768

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01075433AINMDGeriatric Medicine (Family Medicine) Physician
25MA11879900NJMDGeriatric Medicine (Family Medicine) Physician
N9976TXMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Feb 4, 2024 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Feb 4, 2024 Accepting new patients
Indiana University Health Care Associates, Inc CurrentSince Aug 1, 2015 Accepting new patients
Indiana University Health, Inc CurrentSince Jan 14, 2020 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

5208 Reliable Pkwy
Chicago, IL 60686

2242 Reliable Pkwy
Chicago, IL 60686

1701 N Senate Blvd
Bldg C6
Indianapolis, IN 46202
Phone (913) 962-2000

720 Eskenazi Ave
Fl 2
Indianapolis, IN 46202
Phone (317) 278-5316

250 N Shadeland Ave
Ste 200
Indianapolis, IN 46219
Phone (317) 962-4836

2732 W Michigan St
Indianapolis, IN 46222
Phone (317) 554-4600

720 Eskenazi Ave
Indianapolis, IN 46202
Phone (317) 880-0000

1633 N Capitol Ave
Indianapolis, IN 46202
Phone (317) 962-2929

250 N Shadeland Ave
Ste 130
Indianapolis, IN 46219
Phone (317) 962-4836

7140 E Washington St
Ste 100
Indianapolis, IN 46219
Phone (317) 812-2760

720 Eskenazi Ave
Fl 5
Indianapolis, IN 46202
Phone (317) 880-6000

1633 N Capitol Ave
Ste 322
Indianapolis, IN 46202
Phone (317) 962-2929

720 Eskenazi Ave
Fl 6
Indianapolis, IN 46202
Phone (317) 880-0000

2209 John R Wooden Dr
Martinsville, IN 46151
Phone (765) 342-3364

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

360 Essex St
Ste 303
Hackensack, NJ 07601
Phone (551) 996-8100

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

650 From Rd
Ste 506
Paramus, NJ 07652
Phone (551) 996-1342

Interoperability endpoints

  • Direct secure messaging: kamal.wagle@direct.hackensackmeridian.org
  • Direct secure messaging: kwagle@direct.iuhealth.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 7

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1013249838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 66 FL 3",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 ESSEX ST STE 303",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076018566",
            "telephone_number": "551-996-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGLE",
        "first_name": "KAMAL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-03",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01075433A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N9976",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "N9976",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "IN",
            "license": "01075433A",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA11879900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201291250",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.