Jake Wagner

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

550 S Jackson St # A3K00
Louisville, KY 40202-1622

Phone

(502) 852-4277

NPI assigned

Mar 29, 2022

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1114667334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S JACKSON ST # A3K00",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021622",
            "telephone_number": "502-852-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S JACKSON ST # A3K00",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021622",
            "telephone_number": "502-852-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair Kelly Wagner, DNP
• Bradley Mann Wagner, PT, DPT
• Cynthia Yvonne Wagner
• Dana Wagner
• Dennis E Wagner, ED.D.
• Jessica Ann Wagner, RPH, PHARMD, BCPS
• Joseph Lawrence Wagner III, DMD
• Laura McCauley Wagner, LMFT
• Logan Joseph Wagner
• Marilyn M Wagner, PH.D.

• Student in an Organized Health Care Education/Training Program in Louisville, KY
• Providers in Louisville, KY by specialty
• Student in an Organized Health Care Education/Training Program in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.