Active NPI
Keith Harold Wagoner, COUNSELOR
- Case Manager/Care Coordinator
- Sacramento, CA
National Provider Identifier
1114268588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2150 Stockton Blvd
Sacramento, CA 95817-1337 - Phone
- (916) 875-1000
- NPI assigned
- Mar 11, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | A022760416 | CA | |
| Case Manager/Care Coordinator | 171M00000X | Primary | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X |
Addresses
Primary practice location
2150 Stockton Blvd
Sacramento, CA 95817-1337
Mailing address
2150 Stockton Blvd
Sacramento, CA 95817-1337
Phone (916) 875-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101Y00000X | Medicaid | CA |
Other names 1
- Keith Harold Thigpen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A022760416 | CA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eldorado Community Service Center | Past | Accepting new patients | |
| West County Medical Corporation | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Primary Care Clinic/Center
- Long Beach, CA
- NPI 1568722890
-
- Community Health Clinic/Center
- Long Beach, CA
- NPI 1750537437
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1114268588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2150 STOCKTON BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958171337",
"telephone_number": "916-875-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 STOCKTON BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958171337",
"telephone_number": "916-875-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "KEITH",
"middle_name": "HAROLD",
"credential": "COUNSELOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-11",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "A022760416",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101Y00000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KEITH",
"last_name": "THIGPEN",
"middle_name": "HAROLD",
"credential": "COUNSELOR",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.