Jill Shelton Wagers, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D3176 Issued in ID

Practice address

7235 Emerald St
Suite B
Boise, ID 83704-8600

Phone

(208) 376-7740

Fax

(208) 376-0468

NPI assigned

Sep 6, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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.

• Boise Bench Dentistry

  • Dentist
  • Boise, ID
  • NPI 1770770026
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215030184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7235 EMERALD ST",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048600",
            "telephone_number": "208-376-7740",
            "fax_number": "208-376-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7235 EMERALD ST",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048600",
            "telephone_number": "208-376-7740",
            "fax_number": "208-376-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGERS",
        "first_name": "JILL",
        "middle_name": "SHELTON",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6G595",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Cramer Wade, PA, RD
• Samantha Wade, RD
• Anant Wadhwa
• Thomas Gill Wadsworth, PHARM.D.
• Nautica Wager
• Jocelyn M Waggoner, MD
• April Amber Wagner, PHARMD
• Brandon Mark Wagner, DDS
• Edward C Wagner, DMD
• Lacy Rose Wagner, PA

• Dentist in Boise, ID
• Providers in Boise, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.