NPIMap

Individual provider Active NPI

Ryan J Wagner

  • Sports Medicine (Emergency Medicine) Physician
  • Appleton, WI
National Provider Identifier
1275087207
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X
License
68001 Issued in WI
Practice address
2400 E Capitol Dr
Appleton, WI 54911-8728
Phone
(920) 454-3300
Fax
(920) 531-2098
NPI assigned
Aug 8, 2016
Last updated
Feb 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Emergency Medicine) Physician 207PS0010X 68001 WI Primary
Orthopaedic Surgery Physician 207X00000X 68001 WI

Addresses

Primary practice location

2400 E Capitol Dr
Appleton, WI 54911-8728

Mailing address

2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 831-5050

Other practice location 1

721 E Meadow Grove Blvd
Appleton, WI 54915-4509
Phone (920) 585-2839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20180206002309 WI Practitioner - Sports MedicinePractitioner - Orthopedic SurgeryPractitioner - Emergency Medicine 0547558041 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Emergency Medicine, Orthopedic Surgery
Education
Midwestern University, Chicago College of Osteopathic Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

820 E Grant St
Appleton, WI 54911-3483
Phone (920) 831-5050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68001WIMDSports Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Aug 1, 2020 Accepting new patients
Mercy Health System Corporation CurrentSince Jan 25, 2018 Accepting new patients
Mercy Health System Corporation CurrentSince Jan 25, 2018 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2400 E Capitol Dr
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

1516 S Commercial St
Neenah, WI 54956
Phone (920) 725-0077

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

902 Riverside Dr
Ste 203
Waupaca, WI 54981
Phone (715) 258-0242

Interoperability endpoints

  • Direct secure messaging: rwagner205420@direct.thedacare.org

Organizations & group practices 5

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1275087207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118728",
            "telephone_number": "920-831-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118728",
            "telephone_number": "920-454-3300",
            "fax_number": "920-531-2098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "721 E Meadow Grove Blvd",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549154509",
            "country_code": "US",
            "telephone_number": "920-585-2839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RYAN",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-08",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "WI",
            "license": "68001",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "68001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.