NPIMap

Individual provider Active NPI

George M Wagner, MD

  • Family Medicine Physician
  • Faribault, MN
National Provider Identifier
1356301048
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34981 Issued in MN
Practice address
100 State Ave
Faribault, MN 55021-6337
Phone
(507) 334-3921
Fax
(507) 332-5299
NPI assigned
Mar 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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 34981 MN Primary

Addresses

Primary practice location

100 State Ave
Faribault, MN 55021-6337

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000

Other identifiers 1

IdentifierTypeStateIssuer
779502500MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gwagner87686@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20100201000730 MN Practitioner - Family Practice 4981747839 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

  • Allina Health Home Health Home health agency, Minneapolis, MN, CCN 248091
  • Home Health Care Inc Home health agency, Golden Valley, MN, CCN 248037
  • Adara Home Health Inc Home health agency, Buffalo, MN, CCN 248056
  • Allina Health Faribault Medical Center Hospital, Faribault, MN, CCN 240071
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Northfield Hospital Hospital, Northfield, MN, CCN 240014
  • Owatonna Hospital Hospital, Owatonna, MN, CCN 240069

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
Allina Health System Family Medicine CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Family Medicine Current Accepting new patients
Allina Health System Past Accepting new patients
Allina Health System Family Medicine Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

100 State Ave
Faribault, MN 55021
Phone (507) 334-3921

200 State Ave
Faribault, MN 55021
Phone (507) 334-6451

1175 Nininger Rd
Hastings, MN 55033
Phone (651) 404-1000

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Interoperability endpoints

  • Direct secure messaging: gwagner87686@excellian.direct.allina.com
  • Direct secure messaging: george.wagner.1@21423.direct.athenahealth.com

Organizations & group practices 7

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 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1356301048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STATE AVE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550216337",
            "telephone_number": "507-334-3921",
            "fax_number": "507-332-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GEORGE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "34981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "779502500",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gwagner87686@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "100 State Ave",
            "city": "Faribault",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550216337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.