Peter J Wagner, M.D.
Individual provider Active NPI Orthopaedic Surgery Physician · Providence, RI
NPI 1285995100 · NPPES record last updated Jun 26, 2018
Key facts
- NPI
- 1285995100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- MD16294 (RI)
- Practice address
- 2 Dudley St Ste 200
Providence, RI 02905 - Phone
- (401) 330-1476
- NPI assigned
- Jun 7, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Norwich Orthopedic Group PC
Ptsma Inc
Practice addresses (Care Compare)
101 Airport Rd
Westerly, RI 02891-3432
Phone (860) 889-7345
326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331
37 S Broad St
Pawcatuck, CT 06379-7909
Phone (860) 495-1919
82 New Park Ave
North Franklin, CT 06254-1807
Phone (860) 889-7345
Hospital & facility affiliations
- Hartford Healthcare at Home
- Atrinity Home Health
- Lawrence & Memorial Hospital
- Windham Community Memorial Hospital
- William W Backus Hospital
- Westerly Hospital
- Day Kimball Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.95 of 100
- Quality
- 83.12
- Improvement activities
- 40
- Cost
- 84.36
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 113 |
| Laminectomy or laminotomy (partial removal of spine bones) | 31 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in RI, CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180712003145 | RI | Practitioner - Orthopedic Surgery | 1759637275 | Reassigns benefits to 1 organization |
| I20190613001887 | CT | Practitioner - Orthopedic Surgery | 1759637275 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253099 | MA | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norwich Orthopedic Group, P.C. | Orthopaedic Surgery | Current |
Accepting new patients |
| Norwich Orthopedic Group, P.C. | Orthopaedic Surgery | Current |
Accepting new patients |
Locations
365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364
11 Industrial Park Rd
Niantic, CT 06357
Phone (860) 391-9397
82 New Park Ave
North Franklin, CT 06254
Phone (860) 889-7345
326 Washington St
Norwich, CT 06360
Phone (860) 701-0140
5 Founders St
Ste 203
Willimantic, CT 06226
101 Airport Rd
Westerly, RI 02891
Phone (401) 596-0259
Interoperability endpoints
- pwagner439061@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 253099 | MA | |
| Orthopaedic Surgery Physician | 207X00000X | MD16294 | RI | Yes |
Addresses
Primary practice location
2 Dudley St Ste 200
Providence, RI 02905
Mailing address
PO Box 1119
Providence, RI 02901-1119
Phone (401) 443-4150
NPI Registry JSON
{
"created_epoch": "1339027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529971200000",
"number": "1285995100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1119",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029011119",
"telephone_number": "401-443-4150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 DUDLEY ST STE 200",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "02905",
"telephone_number": "401-330-1476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "PETER",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-07",
"last_updated": "2018-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MA",
"license": "253099",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "RI",
"license": "MD16294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
- Heather Waddell
- Neha Wadhavkar
- Kenneth Judson Wagg
- Chad Michael Waggoner
- Laurie Wagner-Abreu
- Richard Laverne Wagner
- Stephanie Bing Wagner
- Ayman M. Wahbeh
- Benjamin Waite
- Joanne M Waite
All providers in Providence, RI · Orthopaedic Surgery Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.