Individual provider Active NPI

Scott Wagner, MSPT

  • Orthopedic Physical Therapist
  • McLean, VA
National Provider Identifier
1053433128
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
2305202514 Issued in VA
Practice address
6849 Old Dominion Dr
McLean, VA 22101-3724
Phone
(703) 848-9333
NPI assigned
Apr 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 2305202514 VA Primary

Addresses

Primary practice location

6849 Old Dominion Dr
McLean, VA 22101-3724

Mailing address

516 Greenwich St
Falls Church, VA 22046-2501
Phone (703) 587-8670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041015000136 DC Practitioner - Physical Therapist in Private Practice 1254391097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
May accept Medicare assignment
Group practices
Pro Motion Physical Therapy, LLCGroup PAC ID 3971402348, 7 clinicians

Practice addresses (Care Compare)

6849 Old Dominion Dr
Suite 330
MC Lean, VA 22101-3791
Phone (703) 848-9333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pro Motion Physical Therapy, LLC CurrentSince Jan 1, 2008 Accepting new patients
Hand-N-Hand Therapy, LLC Orthopedic Past Accepting new patients

Locations

6849 Old Dominion Dr
Ste 330
McLean, VA 22101
Phone (703) 848-9333

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053433128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 GREENWICH ST",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220462501",
            "telephone_number": "703-587-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6849 OLD DOMINION DR",
            "city": "MCLEAN",
            "state": "VA",
            "postal_code": "221013724",
            "telephone_number": "703-848-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "VA",
            "license": "2305202514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McLean, VA

Sources for this page

  • 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.