Jacquelynn Wagoner, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

20A15405 Issued in CA

Practice address

2823 Fresno St
Fresno, CA 93721-1324

Phone

(559) 499-6556

NPI assigned

Apr 19, 2015

Last updated

Jan 10, 2020By the provider in NPPES

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

Other names 1

• Jacquelynn Crumpacker Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacquelynn.wagoner.1@17661.direct.athenahealth.com

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.

• Central California Faculty Medical Group, Inc.

  • Emergency Medicine Physician
  • Fresno, CA
  • NPI 1457603573
  Medicare reassignment NPD
• University Faculty Associates, Inc.

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1073911137

  Pediatrics

  Medicare reassignment NPD
• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852

  Pediatrics

  NPD
• University Faculty Associates , Inc.

  • Vascular Surgery Physician
  • Fresno, CA
  • NPI 1881092963
  NPD
• United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Orange Cove, CA
  • NPI 1649252198
  NPD (past)

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

{
    "created_epoch": "1429401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1184011074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211324",
            "telephone_number": "559-499-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JACQUELYNN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-19",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A15405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYNN",
            "last_name": "CRUMPACKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anneliese Wagner
• Janine Marie Wagner, LMFT
• Melissa Wagner, M.A.
• Mildred Gayamo Wagner
• Eric Matthew Wagoner, PA-C
• Sharon Wahyudi
• Wai S. Lee MD, Professional Corporation
• Andrew N Waireri, NP-C
• Leanne Wakefield, LCSW
• Frank Waldrop, M.D.

• Pediatrics Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; 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.