Philip Jon Wagner, DC

Primary specialty

Internist ChiropractorTaxonomy code 111NI0900X

License

1633 Issued in SC

Practice address

1 Pinckney Blvd
Naval Hospital Beaufort Attn Professional Affairs
Beaufort, SC 29902-6122

Phone

(843) 228-5577

Fax

(843) 228-5196

NPI assigned

Dec 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life University, Inc.Group PAC ID 7214927284, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: philip.wagnerdc.p1@direct.life.nextgenshare.com

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.

• Life University, Inc

  dba Center for Health and Optimum Performance - C-HOP

  • Clinic/Center
  • Marietta, GA
  • NPI 1902033343
  Medicare reassignment Care Compare group NPD
• Life University Inc

  • Chiropractor
  • San Juan, PR
  • NPI 1508580978
  NPD

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043296171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PINCKNEY BLVD",
            "address_2": "NAVAL HOSPITAL BEAUFORT ATTN PROFESSIONAL AFFAIRS",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299026122",
            "telephone_number": "843-228-5577",
            "fax_number": "843-228-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PINCKNEY BLVD",
            "address_2": "NAVAL HOSPITAL BEAUFORT ATTN PROFESSIONAL AFFAIRS",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299026122",
            "telephone_number": "843-228-5577",
            "fax_number": "843-228-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PHILIP",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "SC",
            "license": "1633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Vossler
• Austin Joseph Voves, DDS
• Robert G Vyge, M.D.
• Stephen Michael Wade, DMD
• Denise Lea Wagner, CNM
• Wal-Mart Stores East LP (Walmart Pharmacy 10-7181)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1383)
• Wal-Mart Stores East, LP (Walmart Vision Center 30-7181)
• Wal-Mart Stores East, LP (Vision Center 30-1383)
• Walgreen Co (Rite Aid)

• Internist Chiropractor in Beaufort, SC
• Providers in Beaufort, SC by specialty
• Internist Chiropractor in South Carolina

• 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.
• 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.

Verify at the official NPI Registry.