NPIMap

Individual provider Active NPI

Matthew M Wagner, MD

  • Diagnostic Radiology Physician
  • Columbus, OH
National Provider Identifier
1144219403
Registry record updated Mar 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
35080926 Issued in OH
Practice address
793 W State St
Columbus, OH 43222-1551
Phone
(614) 234-5100
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 35080926 OH Primary

Addresses

Primary practice location

793 W State St
Columbus, OH 43222-1551

Mailing address

Dept L-647
Columbus, OH 43260-0001
Phone (866) 287-0568

Other identifiers 1

IdentifierTypeStateIssuer
2317022MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwagner1157972@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040921000351 OH Practitioner - Diagnostic Radiology 2961470653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Ohio State University College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology IncGroup PAC ID 1658274543, 56 clinicians

Practice addresses (Care Compare)

793 W State St
Columbus, OH 43222-1551
Phone (614) 234-5100

Hospital & facility affiliations

  • Ohio Valley Surgical Hospital Hospital, Springfield, OH, CCN 360355
  • Mount Carmel East & West Hospital, Columbus, OH, CCN 360035
  • Mount Carmel St Ann'S Hospital, Westerville, OH, CCN 360012
  • Mount Carmel New Albany Surgical Hospital Hospital, New Albany, OH, CCN 360266
  • Diley Ridge Medical Center Hospital, Canal Winchester, OH, CCN 360358

Merit-based Incentive Payment System (MIPS)

Final score
81.62 of 100Reported as group
Quality
75.91
Improvement activities
40
Cost
82.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35080926OHMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Inc Diagnostic Radiology CurrentSince May 17, 2002 Accepting new patients

Locations

793 W State St
Columbus, OH 43222
Phone (614) 234-1862

Dept L647
Columbus, OH 43260

10330 Sawmill Pkwy
Ste 500
Powell, OH 43065
Phone (614) 234-0522

Organizations & group practices 1

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648252800000",
    "number": "1144219403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT L-647",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432600001",
            "telephone_number": "866-287-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 W STATE ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221551",
            "telephone_number": "614-234-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MATTHEW",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2022-03-26",
        "certification_date": "2022-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35080926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2317022",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwagner1157972@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mount Carmel Health Columbus Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "793 W State St",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432221551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.