Individual provider Active NPI

John F Wagner, MD

  • Obstetrics & Gynecology Physician
  • Indianapolis, IN
National Provider Identifier
1336121870
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
01039812A Issued in IN
Practice address
7120 Clearvista Dr
Suite 4000
Indianapolis, IN 46256-1774
Phone
(317) 577-7444
Fax
(317) 577-7433
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 01039812A IN Primary

Addresses

Primary practice location

7120 Clearvista Dr
Suite 4000
Indianapolis, IN 46256-1774

Mailing address

6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2805

Other identifiers 2

IdentifierTypeStateIssuer
100370080MedicaidIN
000000647926OtherINANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwagner10731@eCommunityDirect.com Community Physicians of Indiana Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20070427000221 IN Practitioner - Obstetrics/Gynecology 5193821791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Indiana University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

7120 Clearvista Dr
Suite 4000
Indianapolis, IN 46256-1774
Phone (317) 621-7444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01039812AINMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Apr 1, 2010 Accepting new patients
Community Physicians of Indiana Inc Obstetrics & Gynecology CurrentSince Apr 1, 2010 Accepting new patients
Major Hospital Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

8040 Clearvista Pkwy
Ste 490
Indianapolis, IN 46256
Phone (317) 577-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

9669 E 146th St
Ste 350
Noblesville, IN 46060
Phone (317) 621-2312

Interoperability endpoints

  • Direct secure messaging: jwagner10731@ecommunitydirect.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1336121870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 CLEARVISTA DR",
            "address_2": "SUITE 4000",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561774",
            "telephone_number": "317-577-7444",
            "fax_number": "317-577-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOHN",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01039812A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100370080",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000647926",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwagner10731@eCommunityDirect.com",
            "affiliation": "Y",
            "affiliationName": "Community Physicians of Indiana Inc",
            "address_1": "7120 Clearvista Dr",
            "address_2": "Suite 4000",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462561774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.