John Wagner, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

MD.201230 Issued in LA

Practice address

7330 Fern Ave Ste 704
Shreveport, LA 71105-4985

Phone

(318) 798-8261

Fax

(316) 798-8263

NPI assigned

May 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

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

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.

• Brentwood Acquisition-Shreveport Inc.

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1164725701
  Medicare reassignment NPD
• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222

  Psychiatry

  Medicare reassignment NPD
• John H Wagner,III,MD,LLC

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1609202332
  NPD (past) Authorized official
• Brentwood Acquisition-Shreveport Inc.

  • Psychiatric Hospital
  • Shreveport, LA
  • NPI 1417979204

  Psychiatry

  NPD
• Laura C McFerrin, BCSW, LCSW

  • Clinical Social Worker
  • Shreveport, LA
  • NPI 1205135308
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1033320577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7330 FERN AVE STE 704",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054985",
            "telephone_number": "318-798-8261",
            "fax_number": "316-798-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7330 FERN AVE STE 704",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054985",
            "telephone_number": "318-798-8261",
            "fax_number": "316-798-8263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "LA",
            "license": "MD.201230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1214841",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - PTAN",
            "identifier": "4P278F600",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Renee Waggoner
• Sharon Waggoner, MSW
• Catherine C Wagner, CRNA
• Diane Brown Wagner, MD
• Elizabeth Hansen Wagner, PT, DPT
• Sarah Wagner
• Hillary Wagnon
• Lauren Wagnon, PLPC
• Tyler Wagnon, HIS
• Nicole Devona Wahsington

• Child & Adolescent Psychiatry Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Child & Adolescent Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.