Todd Emmit Wagner, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.099746 Issued in OH

Practice address

21100 Southgate Park Blvd
Maple Heights, OH 44137-3004

Phone

(216) 663-6100

Fax

(216) 395-1071

NPI assigned

Jun 29, 2008

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 OH

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twagner327839@direct.ochin.org
• Direct secure messaging: twagner117119@direct.metrohealth.org

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.

• Signature Health, Inc.

  • Mental Health Counselor
  • Garfield Heights, OH
  • NPI 1679767289
  Medicare reassignment NPD
• Signature Health Inc

  • Long Term Care Pharmacy
  • Willoughby, OH
  • NPI 1740502335
  NPD
• Signature Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Willoughby, OH
  • NPI 1477575348
  NPD
• The Metrohealth System

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1700828852
  NPD
• Signature Health Inc.

  • Physiological Laboratory
  • Painesville, OH
  • NPI 1184170136
  NPD (past)
• Signature Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Ashtabula, OH
  • NPI 1336687482
  NPD (past)
• Signature Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Willoughby, OH
  • NPI 1306612882
  NPD (past)

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

{
    "created_epoch": "1214697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1063674299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21100 SOUTHGATE PARK BLVD",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441373004",
            "telephone_number": "216-663-6100",
            "fax_number": "216-395-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21100 SOUTHGATE PARK BLVD",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441373004",
            "telephone_number": "216-663-6100",
            "fax_number": "216-395-1071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 Saint Clair Ave NE",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441142004",
            "country_code": "US",
            "telephone_number": "216-781-6228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TODD",
        "middle_name": "EMMIT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-29",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.099746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Verde, COTA/L
• Yukimi Ann Viccaro, RPH
• Autumn Vinciquerra, LPCC
• Vip Smiles Johnson Dental Inc
• Kandyse Shanell Wagner
• Tyrone L Wagner
• Walgreen Co
• Chudney Walker, LMT
• Keisha Walker, RN
• Briasja Tamar Ware

• Family Medicine Physician in Maple Heights, OH
• Providers in Maple Heights, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; 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.