Benjamin Wagga

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2024027381 Issued in OK

Practice address

4815 S Harvard Ave Ste 360
Tulsa, OK 74135-3077

Phone

(918) 876-0606

Fax

(918) 876-0604

NPI assigned

Jun 21, 2024

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

Enrolled in OK

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Faith Health Center,LLCGroup PAC ID 7517365448, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Faith Health Center, LLC

  • Psychiatry Physician
  • Tulsa, OK
  • NPI 1336811041
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1114761301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 311",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740370311",
            "telephone_number": "918-876-0606",
            "fax_number": "918-876-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 S HARVARD AVE STE 360",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741353077",
            "telephone_number": "918-876-0606",
            "fax_number": "918-876-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGA",
        "first_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OK",
            "license": "2024027381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Wadley
• Darwin E Wadsworth Jr., O.D.
• Camille Lorraine Wafer
• Elisabeth Ann Wagenblast, LPN
• Karissa McNeal Wagenblatt, APRN-CNP
• Judy K Wagga
• Shelley Waggoner
• Wagner Family Chiropractic PC
• Jared Miller Wagner, PHARMD
• Josie Wagner

• Psychiatric/Mental Health Nurse Practitioner in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.