Alison Wagner

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

758058 Issued in TX

Practice address

1023 Lipscomb St Ste 200
Fort Worth, TX 76104-3102

Phone

(817) 915-4784

NPI assigned

Feb 7, 2023

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

Medicare fee-for-service enrollment

Enrolled in TX

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

State licenses

Practice roles

Locations

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.

• Memorial Hermann Hospital Based Physician Group

  • Emergency Medicine Physician
  • Houston, TX
  • NPI 1295363497
  Medicare reassignment NPD
• Siripurapu Associates PLLC Medical Associates of North Texas

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1023495702
  Medicare reassignment
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Irving, TX
  • NPI 1053397331
  Medicare reassignment
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Flower Mound, TX
  • NPI 1689650475
  NPD
• Fort Worth Institute of Medical Sciences LLC

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1689455685
  NPD (past)

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1154027472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 LIPSCOMB ST STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043102",
            "telephone_number": "817-915-4784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 LIPSCOMB ST STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043102",
            "telephone_number": "817-915-4784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ALISON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "758058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Waggener, MD
• Nathan Waggoner
• Charlyn Pafford Wagley
• Kristin Wagman
• Paul Andrew Wagman
• Beatrix Wagner, PSY.D.
• Christina Marie Wagner
• Daniel B. Wagner, D.O.
• Diana Cypress Wagner, D.O.
• Elisabeth A Wagner, D.O.

• Medical Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; 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.