Philip A Wagner, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R 147759-3 Issued in MN

Practice address

8990 Springbrook Dr NW
Suite 250
Coon Rapids, MN 55433-5850

Phone

(763) 398-1162

Fax

(763) 398-0124

NPI assigned

Sep 14, 2005

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Minnesota Anesthesia Providers, PAGroup PAC ID 7315848876, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairview Northland Regional Hospital Hospital, Princeton, MN, CCN 240141

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Central Minnesota Anesthesia Providers, PA

  • Certified Registered Nurse Anesthetist
  • Becker, MN
  • NPI 1881689974

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD

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

• Fairview Health Services

  • General Acute Care Hospital
  • Princeton, MN
  • NPI 1841351749
  Care Compare affiliation
• Fairview Health Services

  • General Acute Care Hospital
  • Princeton, MN
  • NPI 1922085299
  Care Compare affiliation

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1265427355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 LINCOLN AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 SPRINGBROOK DR NW",
            "address_2": "SUITE 250",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335850",
            "telephone_number": "763-398-1162",
            "fax_number": "763-398-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PHILIP",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 147759-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "627620200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN",
            "identifier": "676G4WA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy V Votava
• Elizabeth Brindise Voudris, DO
• Muon Vy, DDS
• Sarita M Wachsmuth, LICSW
• Lyle Walter Wagner III, PHD, LP
• Robyn Lynn Wagner, WHNP
• Wal-Mart Stores, Inc.
• Cara Ellen Walcheck, R.D., CDE
• Amanda Marie Wald, PA-C
• Madelyn Marie Wald, PA-C

• Certified Registered Nurse Anesthetist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.