Individual provider Active NPI

Wesley Riggs Bagan, M.D.

  • Surgery Physician
  • Fort Madison, IA
National Provider Identifier
1013919653
Registry record updated Aug 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
27520 Issued in IA
Practice address
5409 Avenue O
Fort Madison, IA 52627-9601
Phone
(319) 376-2134
Fax
(319) 376-2188
NPI assigned
Aug 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 27520 IA Primary

Addresses

Primary practice location

5409 Avenue O
Fort Madison, IA 52627-9601

Mailing address

5409 Avenue O
Fort Madison, IA 52627-9601
Phone (319) 376-2134

Other identifiers 4

IdentifierTypeStateIssuer
IA0128OtherIAJOHN DEERE HEALTH
1061614MedicaidIA
19555OtherIAWELLMARK BLUE CROSS
152975OtherIAIOWA HEALTH SOLUTIONS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20100223000657 IA Practitioner - General Surgery 4587708961

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27520IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Iowa Regional Medical Center, Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185926400000",
    "number": "1013919653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5409 AVENUE O",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526279601",
            "telephone_number": "319-376-2134",
            "fax_number": "319-376-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 AVENUE O",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526279601",
            "telephone_number": "319-376-2134",
            "fax_number": "319-376-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGAN",
        "first_name": "WESLEY",
        "middle_name": "RIGGS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2007-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "27520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "IA0128",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1061614",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS",
            "identifier": "19555",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA HEALTH SOLUTIONS",
            "identifier": "152975",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Madison, IA

Sources for this page

Verify at the official NPI Registry.