Individual provider Active NPI

Diana J Wagner, M.A.

  • Audiologist
  • Columbia, MD
National Provider Identifier
1174616551
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
562 Issued in MD
Practice address
8850 Stanford Blvd Ste 1700
Columbia, MD 21045-4765
Phone
(410) 964-9511
Fax
(410) 964-9513
NPI assigned
Sep 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 562 MD Primary

Addresses

Primary practice location

8850 Stanford Blvd Ste 1700
Columbia, MD 21045-4765

Mailing address

8850 Stanford Blvd Ste 1700
Columbia, MD 21045-4765
Phone (410) 964-9511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111207000380 MD Practitioner - Qualified Audiologist 7810966744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Michigan State University College of Human Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8850 Stanford Blvd
Suite 1700
Columbia, MD 21045-4765
Phone (410) 964-9511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1174616551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8850 STANFORD BLVD STE 1700",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454765",
            "telephone_number": "410-964-9511",
            "fax_number": "410-964-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8850 STANFORD BLVD STE 1700",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454765",
            "telephone_number": "410-964-9511",
            "fax_number": "410-964-9513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DIANA",
        "middle_name": "J",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-30",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MD",
            "license": "562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.