NPIMap

Individual provider Active NPI

Michelle Jayne Wagner, M.D.

  • Family Medicine Physician
  • Burlington, WI
National Provider Identifier
1346566577
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
56951 Issued in WI
Practice address
248 McHenry St
Burlington, WI 53105-1828
Phone
(262) 767-8000
NPI assigned
Apr 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 56951 WI Primary

Addresses

Primary practice location

248 McHenry St
Burlington, WI 53105-1828

Mailing address

248 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-8000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mwagner90137@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130827000910 WI Practitioner - Family Practice 7810130572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

204 S Pine St
Burlington, WI 53105-1914
Phone (419) 221-6717

248 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-8000

Hospital & facility affiliations

  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
  • Aurora at Home Hospice, Wauwatosa, WI, CCN 521528
  • Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059
  • Aurora Lakeland Medical Center Hospital, Elkhorn, WI, CCN 520102
  • West Allis Memorial Hospital Hospital, West Allis, WI, CCN 520139

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56951WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 12, 2013 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 12, 2013 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

248 McHenry St
Burlington, WI 53105
Phone (262) 767-8000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

620 15th Ave
Union Grove, WI 53182
Phone (262) 878-1211

Interoperability endpoints

  • Direct secure messaging: mwagner90137@direct.myadvocateaurora.org

Organizations & group practices 5

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 6

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": "1271116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1346566577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051828",
            "telephone_number": "262-767-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051828",
            "telephone_number": "262-767-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHELLE",
        "middle_name": "JAYNE",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-13",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "56951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwagner90137@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "248 McHenry St",
            "city": "Burlington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531051828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "248 McHenry St",
            "city": "Burlington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531051828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Burlington, WI

Sources for this page

Verify at the official NPI Registry.