Cassie J Wagner, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

C156954 Issued in IA

Practice address

840 W US Highway 18
Garner, IA 50438-1023

Phone

(641) 925-1500

Fax

(641) 925-1507

NPI assigned

Oct 17, 2014

Last updated

Dec 3, 2019By 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 4

Addresses

Other names 1

• Cassie J Broome Former name

Medicare fee-for-service enrollment

Enrolled in IA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwagner1022549@direct.unitypoint.org
• Direct secure messaging: cwagner19618@uihcdirect.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.

• Central Iowa Hospital Corporation

  dba East Des Moines Family Care Center

  • Family Medicine Physician
  • Des Moines, IA
  • NPI 1104879576
  Medicare reassignment NPD
• Trinity Regional Medical Center

  dba UnityPoint Clinic

  • Emergency Medicine Physician
  • Fort Dodge, IA
  • NPI 1073594156
  Medicare reassignment NPD
• Central Iowa Hospital Corporation

  dba IMMC Outpatient Pharmacy

  • Pharmacy
  • Des Moines, IA
  • NPI 1003352949
  NPD
• Central Iowa Hospital Corporation

  dba Blank Health Providers

  • Pediatrics Physician
  • Des Moines, IA
  • NPI 1144309188
  NPD
• St Luke's Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1134523269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 1ST ST SE",
            "city": "BELMOND",
            "state": "IA",
            "postal_code": "504211201",
            "telephone_number": "641-444-3500",
            "fax_number": "515-532-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 W US HIGHWAY 18",
            "city": "GARNER",
            "state": "IA",
            "postal_code": "504381023",
            "telephone_number": "641-925-1500",
            "fax_number": "641-925-1507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051521",
            "country_code": "US",
            "telephone_number": "605-312-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051521",
            "country_code": "US",
            "telephone_number": "605-312-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CASSIE",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-17",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IA",
            "license": "C112229",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C112229",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C156954",
            "primary": true
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "IA",
            "license": "C112229",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSIE",
            "last_name": "BROOME",
            "middle_name": "J",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Roy A Tesene, DDS
• Kendra S Ulicki, ANRP
• Alexander P Vangerpen, DDS
• Vidal Family Dentistry
• Peter L. Vidal, D.D.S
• Scott Bradley Wood, D.C.
• Deena Marie Zadow, ARNP
• Hilary Zrostlik, ARNP

• Pediatric Nurse Practitioner in Garner, IA
• Providers in Garner, IA by specialty
• Pediatric Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; 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.