Active NPI
Jake Wagner
- Student in an Organized Health Care Education/Training Program
- Lebanon, IN
National Provider Identifier
1114667334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1310 S Lebanon St
Lebanon, IN 46052-2792 - Phone
- (765) 485-8950
- Fax
- (765) 485-8959
- NPI assigned
- Mar 29, 2022
- Last updated
- Nov 2, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1310 S Lebanon St
Lebanon, IN 46052-2792
Mailing address
1310 S Lebanon St
Lebanon, IN 46052-2792
Phone (765) 485-8950
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1793577600000",
"number": "1114667334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 S LEBANON ST",
"city": "LEBANON",
"state": "IN",
"postal_code": "460522792",
"telephone_number": "765-485-8950",
"fax_number": "765-485-8959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 S LEBANON ST",
"city": "LEBANON",
"state": "IN",
"postal_code": "460522792",
"telephone_number": "765-485-8950",
"fax_number": "765-485-8959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-29",
"last_updated": "2026-11-02",
"certification_date": "2026-11-02",
"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": []
}Other providers in Lebanon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.