Bradford S. Wagner, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

MD19486 Issued in ME

Practice address

50 Foden Rd Ste 3
South Portland, ME 04106-1718

Phone

(207) 874-1489

Fax

(207) 523-8590

NPI assigned

May 6, 2009

Last updated

Mar 3, 2026By the provider in NPPES

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 ME

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

Specialty

Family PracticeAlso: Sports Medicine

Education

University of Massachusetts Medical School, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intermed PAGroup PAC ID 5092605261, 185 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bradford.wagner@int.eclinicaldirectplus.com

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.

• Intermed, PA

  • Internal Medicine Physician
  • South Portland, ME
  • NPI 1467422733

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Mainehealth

  dba MMP Family Medicine

  • Family Medicine Physician
  • Portland, ME
  • NPI 1639194509
  Medicare reassignment NPD
• Mainehealth

  dba Mainehealth Behavioral Health

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  Medicare reassignment NPD
• Intermed, PA

  • Pediatrics Physician
  • South Portland, ME
  • NPI 1295607836
  NPD
• Mainehealth

  dba MaineHealth Pharmacy Brighton Ave

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  dba MaineHealth Maine Medical Center

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1760436216
  NPD

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1083848030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DR STE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065900",
            "telephone_number": "207-347-2947",
            "fax_number": "207-874-2317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 FODEN RD STE 3",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041061718",
            "telephone_number": "207-874-1489",
            "fax_number": "207-523-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRADFORD",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-06",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD19486",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ME",
            "license": "MD19486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vna Home Health & Hospice (Northern Light Home Care & Hospice)
• Vna Home Health & Hospice (Northern Light Home Care & Hospice)
• Christopher Anh Khoa Vo, MD
• Michael T Voisine, D.O.
• W. David Melevsky, DDS
• Jacklyn Marie Wagner, PT, DPT, ATC
• Rosemarie M Wagner, P.T.
• Timothy C Waite, MD
• Shannyn Waldron, PA-C
• Walgreen Co (Walgreens #19678)

• Sports Medicine (Family Medicine) Physician in South Portland, ME
• Providers in South Portland, ME by specialty
• Sports Medicine (Family Medicine) Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; 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.
• 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.