James S Wagenaar, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

34005359 Issued in OH

Practice address

1408 Campbell Dr
Ironton, OH 45638-2301

Phone

(740) 533-9710

Fax

(740) 533-9712

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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.

• Epmg of Ohio Inc P a

  • Emergency Medicine Physician
  • Portsmouth, OH
  • NPI 1841232196

  Emergency Medicine

  NPD (past)
• Ashland Family Medicine

  • Family Medicine Physician
  • Ashland, KY
  • NPI 1366527467
  NPD (past)
• Dr. Melissa Davis, P.S.C.

  • Family Medicine Physician
  • Ashland, KY
  • NPI 1972792034
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1194768754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 CAMPBELL DR",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456382301",
            "telephone_number": "740-533-9710",
            "fax_number": "740-553-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 CAMPBELL DR",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456382301",
            "telephone_number": "740-533-9710",
            "fax_number": "740-533-9712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 Jackson Pike",
            "address_purpose": "LOCATION",
            "city": "Gallipolis",
            "state": "OH",
            "postal_code": "456311560",
            "country_code": "US",
            "telephone_number": "740-446-5201",
            "fax_number": "740-446-5761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGENAAR",
        "first_name": "JAMES",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34005359",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OH",
            "license": "34005359",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000493481",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCBS",
            "identifier": "000702618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH MEDICAID UNISON",
            "identifier": "000000210197",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH MEDICAID CARESOURCE",
            "identifier": "310917085154",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0043615000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0843529",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erik Vint, RPH
• Tony Virgin, M.D.
• Karen S Waddle, SWA
• Kristina Waddle, LSW
• William Joseph Waddle II
• Brooke Wagner
• Catherine Collins Wagner, FNP
• Donna Wagner
• Jessecca Louise Walcott
• Walgreen Co

• All providers in Ironton, OH
• Emergency Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; 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.