Randall Wagman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M8410 Issued in TX

Practice address

920 Highway 287 N
Ste 300
Mansfield, TX 76063-2627

Phone

(817) 539-0770

Fax

(817) 539-0772

NPI assigned

Jun 14, 2005

Last updated

Feb 14, 2009By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Questcare Hospitalists PLLC

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1265441620
  Medicare reassignment NPD
• Questcare Medical Clinics PLLC

  • Family Medicine Physician
  • Burleson, TX
  • NPI 1821430166
  Medicare reassignment NPD
• Questcare Medical Clinics PLLC

  • Family Medicine Physician
  • Coppell, TX
  • NPI 1336572759
  NPD
• Questcare Medical Clinics PLLC

  • Family Medicine Physician
  • Mansfield, TX
  • NPI 1710329040
  NPD (past)
• Imperial Health LLP

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1326396375
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234569600000",
    "number": "1225033574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 US HIGHWAY 287 N",
            "address_2": "STE 300",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632627",
            "telephone_number": "817-539-0770",
            "fax_number": "817-539-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 HIGHWAY 287 N",
            "address_2": "STE 300",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632627",
            "telephone_number": "817-539-0770",
            "fax_number": "817-539-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGMAN",
        "first_name": "RANDALL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2009-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "11202R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M8410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197913001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1667081",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vohra Post Acute Care Physicians of Texas, PLLC
• Jessica Vu
• Charles V Wabbersen, P.T.
• Antwain Wade
• Sydney Waggoner
• Jeffrey Lynn Wagnon, D.C.
• Paidamoyo Yvonne Wagoneka
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0284)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2397)
• Wal-Mart Stores Texas, LP (Vision Center 30-0284)

• Family Medicine Physician in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2009; 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.