NPIMap

Individual provider Active NPI

Peter J Wagner, M.D.

  • Orthopaedic Surgery Physician
  • Providence, RI
National Provider Identifier
1285995100
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD16294 Issued in RI
Practice address
2 Dudley St Ste 200
Providence, RI 02905
Phone
(401) 330-1476
NPI assigned
Jun 7, 2012
Last updated
Jun 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 253099 MA
Orthopaedic Surgery Physician 207X00000X MD16294 RI Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180712003145 RI Practitioner - Orthopedic Surgery 1759637275 Reassigns benefits to 1 organization
I20190613001887 CT Practitioner - Orthopedic Surgery 1759637275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norwich Orthopedic Group PCGroup PAC ID 6709820798, shared by 3 NPIs, 48 clinicians
Ptsma IncGroup PAC ID 7911800180, shared by 11 NPIs, 173 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
87.95 of 100Reported as group
Quality
83.12
Improvement activities
40
Cost
84.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion113
Laminectomy or laminotomy (partial removal of spine bones)31
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
253099MAMDOrthopaedic Surgery Physician
MD16294RIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norwich Orthopedic Group, P.C. Orthopaedic Surgery CurrentSince Aug 1, 2019 Accepting new patients
Norwich Orthopedic Group, P.C. Orthopaedic Surgery CurrentSince Aug 1, 2019 Accepting new patients

Locations

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

11 Industrial Park Rd
Niantic, CT 06357
Phone (860) 885-7223

82 New Park Ave
North Franklin, CT 06254
Phone (860) 885-7223

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

  • Direct secure messaging: pwagner439061@direct.ynhh.org

Organizations & group practices 2

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 11

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": "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

Sources for this page

Verify at the official NPI Registry.