Individual provider Active NPI

Michael C Wagner II, FNP

  • Family Nurse Practitioner
  • Danville, IL
National Provider Identifier
1073655825
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209003483 Issued in IL
Practice address
1017 W Williams St
Danville, IL 61832-4468
Phone
(217) 213-5254
Fax
(217) 213-5240
NPI assigned
Feb 12, 2007
Last updated
Jan 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209003483 IL Primary

Addresses

Primary practice location

1017 W Williams St
Danville, IL 61832-4468

Mailing address

1017 W Williams St
Danville, IL 61832-4468
Phone (217) 213-5254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080805000589 IL Practitioner - Nurse Practitioner 4587738802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1017 W Williams St
Danville, IL 61832-4468
Phone (217) 213-5254

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Illinois Family Practice Family CurrentSince Dec 1, 2010 Accepting new patients
Helping Hands Medical Clinic LTD CurrentSince Nov 19, 2012 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1017 W Williams St
Danville, IL 61832
Phone (217) 213-5254

603 N Logan Ave
Danville, IL 61832
Phone (217) 213-5254

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1073655825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 W WILLIAMS ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618324468",
            "telephone_number": "217-213-5254",
            "fax_number": "217-213-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 W WILLIAMS ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618324468",
            "telephone_number": "217-213-5254",
            "fax_number": "217-213-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_suffix": "II",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209003483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, IL

Sources for this page

Verify at the official NPI Registry.