Active NPI
Chadwin J Wagener, D.D.S.
- Dentist
- Ankeny, IA
National Provider Identifier
1235257221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7472
- Practice address
- 340 SE Delaware Ave
Ankeny, IA 50021-9346 - Phone
- (515) 964-5482
- Fax
- (515) 964-1956
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7472 | IA | Primary |
Addresses
Primary practice location
340 SE Delaware Ave
Ankeny, IA 50021-9346
Mailing address
833 SE Laurie LN
Ankeny, IA 50021-3667
Phone (515) 964-5482
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 769242 | Other | IA | UNITED CONCORDIA PROV ID |
| 01396 | Other | IA | BLUE DENTAL PROV ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2013 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7472 | IA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ankeny Aesthetic Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Ankeny, IA
- NPI 1205191681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235257221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 SE LAURIE LN",
"city": "ANKENY",
"state": "IA",
"postal_code": "500213667",
"telephone_number": "515-964-5482",
"fax_number": "515-964-1956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 SE DELAWARE AVE",
"city": "ANKENY",
"state": "IA",
"postal_code": "500219346",
"telephone_number": "515-964-5482",
"fax_number": "515-964-1956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENER",
"first_name": "CHADWIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "7472",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROV ID",
"identifier": "769242",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE DENTAL PROV ID",
"identifier": "01396",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ankeny, IA
Sources for this page
- 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.