Active NPI
Jolyn Welsh Wagner, M.D.
- Psychiatry Physician
- Birmingham, MI
National Provider Identifier
1144411091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4301050048
- Practice address
- 999 Haynes St
Suite 280
Birmingham, MI 48009-6712 - Phone
- (248) 258-9085
- NPI assigned
- Aug 6, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301050048 | MI | Primary |
Addresses
Primary practice location
999 Haynes St
Suite 280
Birmingham, MI 48009-6712
Mailing address
999 Haynes St
Suite 280
Birmingham, MI 48009-6712
Phone (248) 258-9085
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 1, 2016 through Jun 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224979200000",
"number": "1144411091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "999 HAYNES ST",
"address_2": "SUITE 280",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096712",
"telephone_number": "248-258-9085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 HAYNES ST",
"address_2": "SUITE 280",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096712",
"telephone_number": "248-258-9085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JOLYN",
"middle_name": "WELSH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-06",
"last_updated": "2008-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301050048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.