Andrew Wagner

Primary specialty

Hand Occupational TherapistTaxonomy code 225XH1200X

License

423249 Issued in OR

Practice address

24076 SE Stark St Ste 200
Gresham, OR 97030-3376

Phone

(503) 674-7860

NPI assigned

Apr 23, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sportscare Physical Therapy @ Cornell, LLCGroup PAC ID 7517115579, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Sportscare Physical Therapy @ Cornell, LLC

  • Physical Therapy Clinic/Center
  • Beaverton, OR
  • NPI 1649534793
  Medicare reassignment Care Compare group NPD
• Armworks Hand Therapy, LLC

  • Customized Equipment (DME)
  • Lake Oswego, OR
  • NPI 1134777691
  NPD
• Armworks Hand Therapy, LLC

  • Occupational Therapist
  • Gresham, OR
  • NPI 1922371947
  NPD
• Sportscare Physical Therapy @ Cornell, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tigard, OR
  • NPI 1255190153

  Hand

  NPD

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1073900320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST STE 200",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303376",
            "telephone_number": "503-674-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST STE 200",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303376",
            "telephone_number": "503-674-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-23",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "OR",
            "license": "423249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Dean Wade, MS, LMT
• Shyra Q Wade, CSWA/QMHA-I
• Brian Wadyka, PHARM.D.
• Michelle K Waggoner, DC
• Shaylene Tamara Waggoner, BSN, RN
• Samantha Wagner
• Wendy Waibel, FNP
• Ryleigh Wainwright
• Ramona Ann Waits, DENTAL ASSISTANT
• Jeff Wakeham

• Hand Occupational Therapist in Gresham, OR
• Providers in Gresham, OR by specialty
• Hand Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.