Amanda C Wagner

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2024020234 Issued in MO

Practice address

1000 W 10TH St
Rolla, MO 65401

Phone

(573) 458-8899

Fax

(573) 341-5611

NPI assigned

Mar 22, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in HI, MO2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Phelps County Regional Medical CenterGroup PAC ID 2860391158, 111 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059
• Phelps County Regional Medical Center Hospital, Rolla, MO, CCN 260017

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Phelps County Regional Medical Center

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1891766051
  Medicare reassignment Care Compare group NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  Medicare reassignment NPD
• Mercy St. Francis Hospital

  • Critical Access Hospital
  • Mountain View, MO
  • NPI 1023053477
  Medicare reassignment NPD
• Medstream Anesthesia Hawaii, LLC

  • Anesthesiology Physician
  • Kamuela, HI
  • NPI 1346621190

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Pacific Anesthesia, Inc

  • Anesthesiology Physician
  • Honolulu, HI
  • NPI 1538472451
  Medicare reassignment NPD
• Pec Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Pearl City, HI
  • NPI 1528305208

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Hollister, MO
  • NPI 1053350454
  NPD
• Mercy St. Francis Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Mountain View, MO
  • NPI 1043357015
  NPD
• Phelps County Regional Medical Center

  • Rural Health Clinic/Center
  • Rolla, MO
  • NPI 1366066037
  NPD

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

• Mercy Hospital Lebanon

  • General Acute Care Hospital
  • Lebanon, MO
  • NPI 1447284898
  Care Compare affiliation
• Mercy Hospital Lebanon

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1740413988
  Care Compare affiliation
• Phelps County Regional Medical Center

  • Rural Health Clinic/Center
  • Salem, MO
  • NPI 1194077701

  Hospital

  Care Compare affiliation
• Phelps County Regional Medical Center

  • Rehabilitation Hospital Unit
  • Rolla, MO
  • NPI 1346287455
  Care Compare affiliation
• Phelps County Regional Medical Center

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1891766051
  Care Compare affiliation

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

{
    "created_epoch": "1584835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1164058020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5645 Main St",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113555045",
            "country_code": "US",
            "telephone_number": "718-670-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "AMANDA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-22",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "RN9407106",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "786638",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2024020234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ve Falkenhain OD & Associates
• Kathleen Ann Vincent, COTA
• Fawad Virk, M.D
• Dana D Voight, M.D.
• Shirley Waggoner, LMSW
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Stephanie Waneka
• Brittany Mechelle Waterworth, NP-C

• Certified Registered Nurse Anesthetist in Rolla, MO
• Providers in Rolla, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.