Michaela Renee Wagner, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS024507 Issued in PA

Practice address

21 Geisinger LN
Lewistown, PA 17044-3400

Phone

(717) 242-4200

Fax

(717) 242-4237

NPI assigned

Apr 5, 2022

Last updated

Jul 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwagner645854@direct.geisinger.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868

  Single Specialty

  Medicare reassignment NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023

  Single Specialty

  NPD
• Geisinger Clinic

  dba PrimeMed Medical Grp Dunmore in collaboration w/Geisinger Clinic

  • Family Medicine Physician
  • Dunmore, PA
  • NPI 1821405408
  NPD
• Geisinger Clinic GYN Onc

  • Obstetrics Physician
  • Wilkes Barre, PA
  • NPI 1346208709
  NPD (past)
• Geisinger Lewistown Hospital

  • General Acute Care Hospital
  • Lewistown, PA
  • NPI 1861545683

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1174264865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "717-242-4200",
            "fax_number": "717-242-4237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GEISINGER LN",
            "city": "LEWISTOWN",
            "state": "PA",
            "postal_code": "170443400",
            "telephone_number": "717-242-4200",
            "fax_number": "717-242-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAELA",
        "middle_name": "RENEE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS024507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Viaquest Behaviaorl Health of PA, LLC
• Valeriy M Vilensky, MD
• Rocco J Volpe, M.D.
• Chelsea M Wade, PA-C
• Marikay Wagner
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1607)
• Wal-Mart Stores East, LP (Vision Center 30-1607)
• Suzanne M. Ward, CRNP PMHNP
• Watson's Optical Inc.
• Norris Blake Webb

• Pediatrics Physician in Lewistown, PA
• Providers in Lewistown, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.
• 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.