Jerry Main Wagner

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C018630 Issued in NC

Practice address

1494 Camp Creek Rd
Union Mills, NC 28167-7900

Phone

(828) 423-6886

NPI assigned

Feb 21, 2022

Last updated

Jun 25, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

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  • NPI 1801472634

  OH

  Medicare reassignment NPD
• Elu LLC

  dba Elu

  • Mental Health Counselor
  • Chattanooga, TN
  • NPI 1396222394

  Clinical

  NPD (past)

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1346995008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1494 CAMP CREEK RD",
            "city": "UNION MILLS",
            "state": "NC",
            "postal_code": "281677900",
            "telephone_number": "828-423-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1494 CAMP CREEK RD",
            "city": "UNION MILLS",
            "state": "NC",
            "postal_code": "281677900",
            "telephone_number": "828-423-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JERRY",
        "middle_name": "MAIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-21",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C018630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Moran
• Sherrie Owens, PTA
• Malinda Noel Salyers
• Union Mille Living Center #2
• Union Mills Living Center #3

• Clinical Social Worker in Union Mills, NC
• Providers in Union Mills, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.