Jessica H Wagener, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0420008940 Issued in VT

Practice address

115 Porter Drive
Porter Hospital
Middlebury, VT 05753

Phone

(802) 388-4001

Fax

(802) 388-5612

NPI assigned

Nov 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwagener15876@direct.uvmhealth.org

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.

• Porter Hospital Inc

  • Critical Access Hospital
  • Middlebury, VT
  • NPI 1740291400
  Medicare reassignment NPD
• Porter Hospital, Inc

  dba Porter Medical Group

  • Family Medicine Physician
  • Middlebury, VT
  • NPI 1134457013
  Medicare reassignment
• Porter Hospital Inc

  • Anesthesiology Physician
  • Middlebury, VT
  • NPI 1871689604
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023180445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 PORTER DRIVE",
            "address_2": "SUSAN SPITZNER FINANCE DEPT",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "05753",
            "telephone_number": "802-388-5607",
            "fax_number": "802-388-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 PORTER DRIVE",
            "address_2": "PORTER HOSPITAL",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "05753",
            "telephone_number": "802-388-4001",
            "fax_number": "802-388-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENER",
        "first_name": "JESSICA",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VT",
            "license": "0420008940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "19935",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN0884",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP VT MGD CARE",
            "identifier": "77V131",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Village Health, Inc.
• Virtual Optics Inc (Middlebury Optics)
• Lydia Vorsteveld, APRN
• Vose Chiropractic (Epic Wellness)
• Erik Stephen Vose, D.C.
• Walgreen Co (Walgreens #18375)
• Anne Wallace, MSW
• Danielle S Wallace
• Kathleen Walls, LCMHC
• Tyler W Wark, MD

• Emergency Medicine Physician in Middlebury, VT
• Providers in Middlebury, VT by specialty
• Emergency Medicine Physician in Vermont

• 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.