Matthew Wagner
Individual provider Active NPI Family Nurse Practitioner · Wabasha, MN
NPI 1053785840 · NPPES record last updated Nov 14, 2018
Key facts
- NPI
- 1053785840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- CNP 4307 (MN)
- Practice address
- 1200 Grant Blvd W
Wabasha, MN 55981 - Phone
- (651) 565-5600
- NPI assigned
- Nov 17, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Georgetown University School of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Elizabeths Hospital of Wabasha Inc
Practice addresses (Care Compare)
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-4531
204 S Main St
Alma, WI 54610-7722
Phone (651) 565-5599
Hospital & facility affiliations
- Gundersen St. Elizabeth'S Home Care
- St Elizabeth Medical Center
- Gundersen Lutheran Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160122000332 | MN | Practitioner - Nurse Practitioner | 4284937418 | Reassigns benefits to 1 organization |
| I20181213002408 | WI | Practitioner - Nurse Practitioner | 4284937418 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 170201-9 | MN | MD | Registered Nurse |
| CNP 4307 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Elizabeths Hospital of Wabasha Inc | Current |
Accepting new patients | |
| Saint Elizabeths Hospital of Wabasha Inc | Current |
Accepting new patients | |
| Saint Elizabeths Hospital of Wabasha Inc | Past | Accepting new patients |
Locations
1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531
Interoperability endpoints
- mwagner472696@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP 4307 | MN | Yes |
| Registered Nurse | 163W00000X | R 170201-9 | MN |
Addresses
Primary practice location
1200 Grant Blvd W
Wabasha, MN 55981
Mailing address
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5600
Other practice location 1
210 9th St SE
Rochester, MN 55904-6756
Phone (507) 288-3443
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CNP 4307 | Other | MN | APRN LICENSE |
| R 170201-9 | Other | MN | RN LICENSE |
Other providers in Wabasha, MN
- Adrienne Terese Tryan
- Jon A Vanloon
- Wabasha County Social Services
- Wabasha Dentistry LLC
- Wabasha-Kellogg #811
- Nicole Marie Wallis
- Julie L Walsh
- Wenden Recovery Services of Wabasha
- Malinda Jean Wise
- Wodele Enterprises Incorporated
All providers in Wabasha, MN · Family Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.