Active NPI
Michael J Wagner
- Medical Oncology Physician
- Boston, MA
National Provider Identifier
1023317898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Oncology Physician
- License
- 1016422
- Practice address
- 450 Brookline Ave
Boston, MA 02215-5450 - Phone
- (617) 632-5204
- Fax
- (617) 632-3408
- NPI assigned
- Mar 19, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Oncology Physician | 207RX0202X | 1016422 | MA | Primary |
| Medical Oncology Physician | 207RX0202X | MD60759395 | WA |
Addresses
Primary practice location
450 Brookline Ave
Boston, MA 02215-5450
Mailing address
450 Brookline Ave
Boston, MA 02215-5450
Phone (617) 632-5204
Other practice location 1
825 Eastlake Ave E
Seattle, WA 98109-4405
Phone (206) 520-5000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023317898 | Medicaid | WA | |
| G8968128 | Other | WA | MEDICARE PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Medical Oncology
- Education
- Harvard Medical School, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Dana-Farber Cancer Institute, Inc.
Practice addresses (Care Compare)
450 Brookline Ave
Boston, MA 02215-5418
Hospital & facility affiliations
- Dana-Farber Cancer Institute
- Brigham and Women'S Hospital
- Massachusetts General Hospital
- Beth Israel Deaconess Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.06 of 100
- Quality
- 65.04
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 69.14
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dana-Farber Cancer Institute, Inc. | Current | Accepting new patients | |
| Dana-Farber Cancer Institute, Inc. | Current | Accepting new patients | |
| Dana-Farber Cancer Institute, Inc. | Medical Oncology | Current | Accepting new patients |
| Dana-Farber Cancer Institute, Inc. | Past | Accepting new patients |
Locations
450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061
Interoperability endpoints
- wagner.michael.dfci@direct.partners.masshiway.net
Organizations & group practices 4
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.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1851333686
-
- Durable Medical Equipment & Medical Supplies
- Chestnut Hill, MA
- NPI 1497429237
-
- Durable Medical Equipment & Medical Supplies
- Boston, MA
- NPI 1225079940
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1548202641
-
- General Acute Care Hospital
- Boston, MA
- NPI 1790717650
-
- General Acute Care Hospital
- Boston, MA
- NPI 1851333686
-
- General Acute Care Hospital
- Boston, MA
- NPI 1023049236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697673600000",
"number": "1023317898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155450",
"telephone_number": "617-632-5204",
"fax_number": "617-632-3408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155450",
"telephone_number": "617-632-5204",
"fax_number": "617-632-3408"
}
],
"practiceLocations": [
{
"address_1": "825 Eastlake Ave E",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981094405",
"country_code": "US",
"telephone_number": "206-520-5000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAGNER",
"first_name": "MICHAEL",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-19",
"last_updated": "2023-10-19",
"certification_date": "2023-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "MA",
"license": "1016422",
"primary": true
},
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "WA",
"license": "MD60759395",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023317898",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN",
"identifier": "G8968128",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.