NPIMap

Individual provider Active NPI

Jill M Wagner, MD

  • Obstetrics & Gynecology Physician
  • High Point, NC
National Provider Identifier
1023097516
Registry record updated Dec 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
9501686 Issued in NC
Practice address
306 Westwood Ave
Suite 501
High Point, NC 27262-4341
Phone
(336) 802-2536
Fax
(336) 802-2534
NPI assigned
Jan 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 9501686 NC Primary

Addresses

Primary practice location

306 Westwood Ave
Suite 501
High Point, NC 27262-4341

Mailing address

1701 Westchester Dr
Suite 850
High Point, NC 27262-7008
Phone (336) 802-2536

Other identifiers 1

IdentifierTypeStateIssuer
8911473MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081106000770 NC Practitioner - Obstetrics/Gynecology 5991723728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Eastern Virginia Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

770 Highland Oaks Dr
Winston Salem, NC 27103-7105
Phone (336) 765-5250

905 Phillips Ave
High Point, NC 27262-7075
Phone (336) 802-2040

Hospital & facility affiliations

  • High Point Regional Health System Hospital, High Point, NC, CCN 340004
  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network, LLC CurrentSince Oct 1, 2012 Accepting new patients
Wake Forest Health Network LLC Obstetrics & Gynecology CurrentSince Oct 1, 2012 Accepting new patients
Wake Forest Health Network LLC Past Accepting new patients
Concord Women'S Specialty Care, Inc. Obstetrics & Gynecology Past Accepting new patients
Cornerstone Health Care PA Past Accepting new patients

Locations

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

306 Westwood Ave
Ste 501
High Point, NC 27262
Phone (336) 885-0149

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

  • Direct secure messaging: jwagner2754819@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354838400000",
    "number": "1023097516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WESTCHESTER DR",
            "address_2": "SUITE 850",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WESTWOOD AVE",
            "address_2": "SUITE 501",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272624341",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JILL",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-12",
        "last_updated": "2012-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "9501686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8911473",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

Verify at the official NPI Registry.