Amy J Wagner, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

52990 Issued in WI

Practice address

9000 W Wisconsin Ave
Pediatric Surgery
Milwaukee, WI 53226-4874

Phone

(414) 266-6550

Fax

(414) 266-6579

NPI assigned

Feb 16, 2007

Last updated

Mar 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.wagner@marshfieldclinichealthsystem.cernerdirect.com
• Direct secure messaging: awagner5803@direct.chw.org

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.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD
• MCHS Hospitals Inc

  dba Marshfield Medical Center

  • Clinic/Center
  • Marshfield, WI
  • NPI 1093221434
  NPD
• Children's Specialty Group, Inc.

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1942970405
  NPD (past)
• Memorial Hospital Inc

  dba Marshfield Medical Center - Neillsville Clinic

  • Rural Health Clinic/Center
  • Neillsville, WI
  • NPI 1619966793
  NPD (past)

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1134263619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC SURGERY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-6550",
            "fax_number": "414-266-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC SURGERY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-6550",
            "fax_number": "414-266-6579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3195 Hillside Dr",
            "address_purpose": "LOCATION",
            "city": "Delafield",
            "state": "WI",
            "postal_code": "530182189",
            "country_code": "US",
            "telephone_number": "414-266-6550",
            "fax_number": "414-266-6579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1655 W Mequon Rd",
            "address_purpose": "LOCATION",
            "city": "Mequon",
            "state": "WI",
            "postal_code": "530923254",
            "country_code": "US",
            "telephone_number": "414-266-6550",
            "fax_number": "414-266-6579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4855 S Moorland Rd",
            "address_purpose": "LOCATION",
            "city": "New Berlin",
            "state": "WI",
            "postal_code": "531517494",
            "country_code": "US",
            "telephone_number": "414-266-6550",
            "fax_number": "414-266-6579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-955-6900",
            "fax_number": "414-955-0079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "AMY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "WI",
            "license": "52990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134263619",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Elizabeth Wagemann, RD
• Mindy Lee Waggoner, PHARM.D
• Rakesh Waghray, MD
• Janak Wagle, M.D
• Erika J Wagner-Martin, LPC
• Bailey Madeline Wagner
• Brett Wagner
• Christopher Joseph Wagner, DO
• Christopher Raymond Wagner, MD
• Jacquelyn Wagner, MS CCC-SLP

• Pediatric Surgery Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Pediatric Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.