NPIMap

Individual provider Active NPI

Michael Wagner, D.O.

  • Anesthesiology Physician
  • Valhalla, NY
National Provider Identifier
1285169037
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
009391 Issued in AZ
Practice address
100 Woods Rd
Valhalla, NY 10595-1530
Phone
(480) 818-3495
NPI assigned
Apr 28, 2017
Last updated
May 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 009391 AZ Primary

Addresses

Primary practice location

100 Woods Rd
Valhalla, NY 10595-1530

Mailing address

4316 E Avalon Dr
#11
Phoenix, AZ 85018-7245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20220728002470 AZ Practitioner - Anesthesiology 8921358169 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

18701 N 67TH Ave
Glendale, AZ 85308-7100
Phone (480) 425-2160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009391AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Spine and Joint Hospital LLC Current Accepting new patients
Cactus Desert Anesthesia PLLC Anesthesiology CurrentSince Sep 1, 2024 Accepting new patients
Anesthesia Partners of Arizona LLC Anesthesiology CurrentSince May 1, 2022 Accepting new patients
Secure Anesthesia PLLC CurrentSince Nov 7, 2022 Accepting new patients
Camelback Anesthesia PLLC CurrentSince Nov 7, 2022 Accepting new patients

Locations

18701 N 67th Ave
Glendale, AZ 85308
Phone (623) 561-1000

13677 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 536-4200

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

4605 E Elwood St
Ste 500
Phoenix, AZ 85040
Phone (469) 998-7443

2421 E Southern Ave
Ste 7
Tempe, AZ 85282
Phone (480) 832-3600

2221 Lakeside Blvd
Ste 600
Richardson, TX 75082
Phone (469) 998-7450

Interoperability endpoints

  • Direct secure messaging: michaelwagner@asjh.medalliesdirect.net

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1285169037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4316 E AVALON DR",
            "address_2": "#11",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WOODS RD",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951530",
            "telephone_number": "480-818-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-28",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "009391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valhalla, NY

Sources for this page

Verify at the official NPI Registry.