Jacquelyn Christine Wagner, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

04-46272 Issued in KS

Practice address

501 S Santa Fe Ave
Suite 100
Salina, KS 67401-4189

Phone

(785) 825-2273

Fax

(785) 825-2275

NPI assigned

Apr 26, 2019

Last updated

Sep 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

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.

• Salina Regional Health Center, Inc

  dba Physician Practice Management

  • Surgery Physician
  • Salina, KS
  • NPI 1619952785

  Hospitalist

  Medicare reassignment NPD
• Salina Regional Health Center Inc

  dba Salina Regional Pain Clinic

  • Pain Medicine (Anesthesiology) Physician
  • Salina, KS
  • NPI 1356203715
  NPD
• Salina Regional Health Center, Inc.

  dba Salina Pediatric Care

  • Pediatrics Physician
  • Salina, KS
  • NPI 1699915934
  NPD
• Salina Regional Health Center, Inc

  • General Acute Care Hospital
  • Salina, KS
  • NPI 1689635138
  NPD (past)

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1235793100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S SANTA FE AVE",
            "address_2": "SUITE 100",
            "city": "SALINA",
            "state": "KS",
            "postal_code": "674014189",
            "telephone_number": "785-825-2273",
            "fax_number": "785-825-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S SANTA FE AVE",
            "address_2": "SUITE 100",
            "city": "SALINA",
            "state": "KS",
            "postal_code": "674014189",
            "telephone_number": "785-825-2273",
            "fax_number": "785-825-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JACQUELYN",
        "middle_name": "CHRISTINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-26",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "R77391",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "0446272",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "04-46272",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KS",
            "license": "04-46272",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004822670001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Volcek, PHARMD
• Michaela Lorene Von Busch, LMSW
• Paula Michelle Vosburg, MS, LCAC
• Tuan Hoang Vu
• Josie Anne Wacker, LCPC
• Karla J Wagner, C.R.N.A.
• Karol Wagner, RN
• Sarah E Wainwright
• Wal-Mart Stores, Inc. (Vision Center 30-0558)
• Walgreen Co (Walgreens #05539)

• Pediatrics Physician in Salina, KS
• Providers in Salina, KS by specialty
• Pediatrics Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.