NPIMap

Individual provider Active NPI

Henry W Wagner, MD

  • Emergency Medicine Physician
  • Derry, NH
National Provider Identifier
1184643587
Registry record updated May 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11547 Issued in NH
Practice address
1 Parkland Dr
Derry, NH 03038-2746
Phone
(603) 421-2220
Fax
(603) 421-2223
NPI assigned
Jul 18, 2006
Last updated
May 3, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11547 NH Primary

Addresses

Primary practice location

1 Parkland Dr
Derry, NH 03038-2746

Mailing address

1 Parkland Dr
Derry, NH 03038-2746
Phone (603) 421-2220

Other identifiers 7

IdentifierTypeStateIssuer
01Y003778NH02OtherNHANTHEM
7770294OtherAETNA
436810OtherHARVARD PILGRIM
2093171MedicaidMA
37305OtherBMC HEALTHNET
30201995MedicaidNH
P00209518OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11547NHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medexpress Urgent Care of Boynton Beach, LLC Past Accepting new patients
Medexpress Urgent Care of West Boca Raton LLC Past Accepting new patients
Emergency Physicians of Derry PLLC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209772800000",
    "number": "1184643587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARKLAND DR",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382746",
            "telephone_number": "603-421-2220",
            "fax_number": "603-421-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARKLAND DR",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382746",
            "telephone_number": "603-421-2220",
            "fax_number": "603-421-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "HENRY",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NH",
            "license": "11547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "01Y003778NH02",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7770294",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "436810",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2093171",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC HEALTHNET",
            "identifier": "37305",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30201995",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00209518",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derry, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.