Wesley Allen Wagar, PA-C
Individual provider Active NPI Surgical Physician Assistant · Kennewick, WA
NPI 1295775427 · NPPES record last updated May 2, 2016
Key facts
- NPI
- 1295775427
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- PA10004591 (WA)
- Practice address
- 711 S Auburn St
Kennewick, WA 99336-5665 - Phone
- (509) 586-2828
- Fax
- (509) 586-2525
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Honorhealth Ambulatory
Practice addresses (Care Compare)
10510 N 92ND St
Scottsdale, AZ 85258-4566
3198 N Windsong Dr
Prescott Valley, AZ 86314-2239
Phone (623) 683-7555
Hospital & facility affiliations
- Yavapai Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220110001430 | AZ | Practitioner - Physician Assistant | 1850281197 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01111 | OR | MD | Surgical Physician Assistant |
| PA10004591 | WA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scottsdale Healthcare Corporation | Current |
Accepting new patients | |
| Honorhealth Ambulatory | Current |
Accepting new patients | |
| Honorhealth Ambulatory | Surgical | Past | Accepting new patients |
| J and D Physical Therapy Services | Past | Accepting new patients | |
| United Early Learning & Family Center LLC | Past |
Accepting new patients |
Locations
16716 E Palisades Blvd
Ste 103
Fountain Hills, AZ 85268
Phone (480) 587-6550
18404 N Tatum Blvd
Ste 101C
Phoenix, AZ 85032
Phone (602) 485-7475
2500 W Utopia Rd
Ste 100
Phoenix, AZ 85027
Phone (623) 683-4462
10510 N 92nd St
Ste 200
Scottsdale, AZ 85258
Phone (480) 323-1250
14674 W Mountain View Blvd
Ste 115
Surprise, AZ 85374
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA01111 | OR | |
| Surgical Physician Assistant | 363AS0400X | PA10004591 | WA | Yes |
Addresses
Primary practice location
711 S Auburn St
Kennewick, WA 99336-5665
Mailing address
711 S Auburn St
Kennewick, WA 99336-5665
Phone (509) 586-2828
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8381717 | Medicaid | WA |
Other providers in Kennewick, WA
- Elizabeth Marie Vossenkemper
- Vue Home Care LLC
- Vue Home Health LLC
- Samuel Waayers
- Carrington M Waddoups
- Erica Y Wagoner
- William S. Waites
- Wal-Mart Stores, Inc
- Linda Lee Walby
- Awnya Walde
All providers in Kennewick, WA · Surgical Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2016. 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.