Kelly E Van Wagner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9533 Issued in NV

Practice address

6380 N. Decatur Blvd
Ste 215
N. Las Vegas, NV 89084

Phone

(702) 948-1145

Fax

(702) 949-6206

NPI assigned

Oct 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellyvanwagner@hcpnv.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Intermountain Medical Holdings Nevada Inc

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279
  Medicare reassignment NPD
• Van Wagner Immediate Care Center

  • Urgent Care Clinic/Center
  • Henderson, NV
  • NPI 1790936458
  NPD (past) Authorized official
• Healthcare Partners Medical Group Coats LTD

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1487631917

  Internal Medicine

  NPD
• Intermountain Medical Holdings Nevada Inc

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD
• Centennial Hills Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1487771812
  NPD (past)
• Desert Springs Hospital

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1154317964
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1447393152
  NPD (past)
• Sunrise Mountainview Hospital, Inc.

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1831143817
  NPD (past)

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1306035571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6380 N. DECATUR BLVD",
            "address_2": "STE 215",
            "city": "N. LAS VEGAS",
            "state": "NV",
            "postal_code": "89084",
            "telephone_number": "702-948-1145",
            "fax_number": "702-949-6206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1380 European Dr",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890524020",
            "country_code": "US",
            "telephone_number": "702-419-3535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6355 S Buffalo Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891132133",
            "country_code": "US",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5230 Boulder Hwy Ste 110",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891226077",
            "country_code": "US",
            "telephone_number": "702-940-1560",
            "fax_number": "702-940-1561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN WAGNER",
        "first_name": "KELLY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-23",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "9533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9533",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICARE",
            "identifier": "V114112",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306035571",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICAID",
            "identifier": "1306035571",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Urbane Care LLC
• VA Southern Nevada
• Robert Joseph Vadovic, RN, MSN, ANP-C
• Gloria Valdovinos
• Tia Star Valentine
• William Vargas
• Michael Vathanasaynee, O.D.
• Vegas Ambulatory Surgery Center LLC
• Mirian Lorena Velazquez Gutierrez
• Luis Alberto Velazquez, M.D.

• Internal Medicine Physician in N. Las Vegas, NV
• Providers in N. Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.