NPIMap

Individual provider Active NPI

Andrew Wagner

  • Vascular & Interventional Radiology Physician
  • Orlando, FL
National Provider Identifier
1215317888
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
ME149963 Issued in FL
Practice address
52 W Underwood St
Orlando, FL 32806-1110
Phone
(321) 842-8475
NPI assigned
Jun 8, 2015
Last updated
Mar 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 266705 MA
Vascular & Interventional Radiology Physician 2085R0204X 2020015515 MO
Vascular & Interventional Radiology Physician 2085R0204X ME149963 FL Primary
Surgery Physician 208600000X 125067171 IL

Addresses

Primary practice location

52 W Underwood St
Orlando, FL 32806-1110

Mailing address

52 W Underwood St
Orlando, FL 32806-1110
Phone (321) 842-8475

Other identifiers 4

IdentifierTypeStateIssuer
110602800MedicaidFL
EKE7EOtherFLBCBS
PS630OtherFLMEDICARE PTAN OHMG
N3348OtherFLMEDICARE PTAN OHRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210715003920 FL Practitioner - Diagnostic Radiology 4981901253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Florida Atlantic University, College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians
Ohri LLCGroup PAC ID 4981912169, 130 clinicians

Practice addresses (Care Compare)

1414 Kuhl Ave
Orlando, FL 32806-2008
Phone (407) 841-5111

398 E Altamonte Dr
Altamonte Springs, FL 32701-4402
Phone (407) 331-9355

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME149963FLMDVascular & Interventional Radiology Physician
2020015515MOMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohri, LLC CurrentSince Jul 1, 2021 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2022 Accepting new patients
Ohi West Medical Group, LLC Diagnostic Radiology CurrentSince Nov 2, 2023 Accepting new patients
Ohri, LLC Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince May 15, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2022 Accepting new patients
Bayfront Health Imaging Center LLC Diagnostic Radiology Past Accepting new patients

Locations

398 E Altamonte Dr
Altamonte Springs, FL 32701
Phone (407) 331-3955

1414 Kuhl Ave
Orlando, FL 32806
Phone (407) 464-9516

20 W Kaley St
Orlando, FL 32806
Phone (407) 423-2581

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

52 Underwood St
Orlando, FL 32806
Phone (321) 841-3581

9400 Turkey Lake Rd
Orlando, FL 32819
Phone (321) 843-5500

9400 Turkey Lake Rd
#P
Orlando, FL 32819
Phone (407) 351-8519

2201 Central Ave
#100
St Petersburg, FL 33713
Phone (727) 321-7057

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: awagner227984@orlandohealth.medalliesdirect.net

Organizations & group practices 8

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1215317888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 W UNDERWOOD ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061110",
            "telephone_number": "321-842-8475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 W UNDERWOOD ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061110",
            "telephone_number": "321-842-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-08",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "266705",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MO",
            "license": "2020015515",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME149963",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125067171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110602800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "EKE7E",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN OHMG",
            "identifier": "PS630",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN OHRI",
            "identifier": "N3348",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.