Dennis E Wagner, ED.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

128987 Issued in KY

Practice address

1169 Eastern Pkwy Ste 2238
Louisville, KY 40217-1444

Phone

(502) 718-9114

Fax

(502) 479-3561

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Edelson and Associates, Inc.

  • Clinical Neuropsychologist
  • Louisville, KY
  • NPI 1952466468
  NPD (past)
• J Bennett Group PSC

  • Clinical Neuropsychologist
  • Louisville, KY
  • NPI 1790955334
  NPD (past)
• Merclan PLLC

  • Group Psychotherapy Psychologist
  • Crestwood, KY
  • NPI 1487687174
  NPD (past)
• Positive Connections, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Crestwood, KY
  • NPI 1861632622
  NPD (past)
• Optum Behavioral Care of North Carolina, P.C.

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1861371718
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1184649402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 RICHMOND DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402051410",
            "telephone_number": "502-718-9114",
            "fax_number": "502-479-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 EASTERN PKWY STE 2238",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171444",
            "telephone_number": "502-718-9114",
            "fax_number": "502-479-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DENNIS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "0810",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "128987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000501117",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89008106",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K113410",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Nicole Waggoner, PTA
• Blair Kelly Wagner, DNP
• Bradley Mann Wagner, PT, DPT
• Cynthia Yvonne Wagner
• Dana Wagner
• Jake Wagner
• Jessica Ann Wagner, RPH, PHARMD, BCPS
• Joseph Lawrence Wagner III, DMD
• Laura McCauley Wagner, LMFT
• Logan Joseph Wagner

• Clinical Psychologist in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.