Mark Andrew Wagner, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

20A5259 Issued in CA

Practice address

36680 Cloverleaf Ave
Madera, CA 93636-8519

Phone

(209) 489-9347

Fax

(209) 720-0107

NPI assigned

Nov 2, 2005

Last updated

Jun 24, 2024By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Diagnostic Radiology

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Medical Imaging Associates IncGroup PAC ID 0446309983, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• California Medical Imaging Associates, Inc

  • Diagnostic Radiology Physician
  • Visalia, CA
  • NPI 1821234899
  Medicare reassignment Care Compare group NPD
• Radiant Imaging Consultants Medical Group Inc

  • Vascular & Interventional Radiology Physician
  • Madera, CA
  • NPI 1497483358
  Medicare reassignment NPD
• Merced Radiology Medical Group

  • Diagnostic Radiology Physician
  • Merced, CA
  • NPI 1992796643
  Authorized official Same address or phone
• Visionary Eye Specialists LLC

  • Ophthalmology Physician
  • Indianapolis, IN
  • NPI 1316566797
  NPD
• California Medical Imaging Associates, Inc

  dba Madera MRI

  • Diagnostic Radiology Physician
  • Madera, CA
  • NPI 1396380424
  NPD (past)
• Universal Radiology Consultants PC

  • Diagnostic Radiology Physician
  • Warner Robins, GA
  • NPI 1689606188
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1336130087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 NORTHSTAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36680 CLOVERLEAF AVE",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368519",
            "telephone_number": "209-489-9347",
            "fax_number": "209-720-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "20A5259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX52590",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "020A52590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Vu, PHARMD
• Kalista Gowlig Vue, PHARMD
• Mai Houa Vue
• Yer Vue
• Moya D Wade
• Steven Lloyd Waite, PHARM.D.
• Walgreen Co (Walgreens #06453)
• Walgreen Co (Walgreens Specialty Pharmacy #12761)
• Walgreen Co (Walgreens #11242)
• Larisa Walk

• Diagnostic Radiology Physician in Madera, CA
• Providers in Madera, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.