Rodger Keith Wagoner, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

006662 Issued in GA

Practice address

2405 Osler CT
Albany, GA 31707-0214

Phone

(229) 435-1458

Fax

(229) 317-2342

NPI assigned

Nov 6, 2012

Sex

Male

Sole proprietor

No

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 GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Albany Area Primary Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1780608992
  Medicare reassignment
• Albany Area Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1013709625
  NPD
• Albany Area Primary Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Leesburg, GA
  • NPI 1568497030
  NPD
• Hospital Authority of the City of Bainbridge and Decatur County

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1194079657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70969",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317080969",
            "telephone_number": "229-435-1458",
            "fax_number": "229-317-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 OSLER CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317070214",
            "telephone_number": "229-435-1458",
            "fax_number": "229-317-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "RODGER",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-06",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VMR Associates Inc
• VMR Associates Inc
• VMR Associates Inc
• Scarlett Ann Wade, FNP-C
• Dylan Waer, PHARMD
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, L.P.

• Physician Assistant in Albany, GA
• Providers in Albany, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; 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.