Active NPI
Andrew Jacob Wagoner, RRT-NPS
- Registered Respiratory Therapist
- Tomah, WI
National Provider Identifier
1336727163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Respiratory Therapist
- License
- 122206
- Practice address
- 500 E Veterans St
Tomah, WI 54660-3105 - Phone
- (608) 372-3971
- NPI assigned
- Apr 1, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | WI | ||
| Neonatal/Pediatric Registered Respiratory Therapist | 2279P3900X | 122206 | WI | |
| Registered Respiratory Therapist | 227900000X | 122206 | WI | Primary |
Addresses
Primary practice location
500 E Veterans St
Tomah, WI 54660-3105
Mailing address
500 E Veterans St
Tomah, WI 54660-3105
Phone (608) 372-3971
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | andrew.wagoner@va.gov | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122206 | WI | MD | Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1336727163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E VETERANS ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546603105",
"telephone_number": "608-372-3971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E VETERANS ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546603105",
"telephone_number": "608-372-3971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "ANDREW",
"middle_name": "JACOB",
"credential": "RRT-NPS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-01",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "WI",
"license": null,
"primary": false
},
{
"code": "2279P3900X",
"taxonomy_group": "",
"desc": "Respiratory Therapist, Registered, Neonatal/Pediatrics",
"state": "WI",
"license": "122206",
"primary": false
},
{
"code": "227900000X",
"taxonomy_group": "",
"desc": "Respiratory Therapist, Registered",
"state": "WI",
"license": "122206",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "andrew.wagoner@va.gov",
"affiliation": "N",
"endpointDescription": "secure email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "500 E Veterans St",
"city": "Tomah",
"state": "WI",
"country_code": "US",
"postal_code": "546603105",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.