NPIMap

Individual provider Active NPI

Gordon R Wagler, MD

  • Internal Medicine Physician
  • Greenwood, SC
National Provider Identifier
1144780958
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
88395 Issued in SC
Practice address
104 Liner Dr
Greenwood, SC 29646-2310
Phone
(864) 227-1115
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 88395 SC Primary

Addresses

Primary practice location

104 Liner Dr
Greenwood, SC 29646-2310

Mailing address

104 Liner Dr
Greenwood, SC 29646-2310
Phone (864) 227-1115

Other practice location 1

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220826000561 SC Practitioner - Internal Medicine 8820327521 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Carolina School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

104 Liner Dr
Greenwood, SC 29646-2310
Phone (864) 227-1115

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Hospital & facility affiliations

  • Home Health Services of Self Regional Healthcare Home health agency, Greenwood, SC, CCN 427018
  • NHC Homecare Greenwood Home health agency, Greenwood, SC, CCN 427075
  • Amedisys Home Health of Clinton Home health agency, Clinton, SC, CCN 427116
  • Self Regional Healthcare Hospital, Greenwood, SC, CCN 420071
  • Abbeville Area Medical Center Hospital, Abbeville, SC, CCN 421301

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
88395SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Aug 15, 2022 Accepting new patients
Self Regional Healthcare CurrentSince Oct 3, 2025 Accepting new patients
Self Regional Healthcare Current Accepting new patients
Self Regional Healthcare Internal Medicine CurrentSince Oct 3, 2025 Accepting new patients
Self Medical Group CurrentSince Aug 15, 2022 Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6793
Chicago, IL 60675

75 Remittance Dr
Dept 6764
Chicago, IL 60675

104 Liner Dr
Greenwood, SC 29646
Phone (864) 227-1115

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: gwagler538310@selfregional.direct-ci.net

Organizations & group practices 8

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 9

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1144780958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462310",
            "telephone_number": "864-227-1115",
            "fax_number": "864-227-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462310",
            "telephone_number": "864-227-1115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Spring St",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463860",
            "country_code": "US",
            "telephone_number": "864-725-4272",
            "fax_number": "864-725-4452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGLER",
        "first_name": "GORDON",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "88395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.