Active NPI
Charles John Wagner, MD
- Allergy & Immunology Physician
- Salem, OR
National Provider Identifier
1366540742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- OR14081
- Practice address
- 1793 13TH St SE
Salem, OR 97302-2541 - Phone
- (503) 362-8385
- Fax
- (503) 362-8435
- NPI assigned
- Sep 20, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | OR14081 | OR | Primary |
Addresses
Primary practice location
1793 13TH St SE
Salem, OR 97302-2541
Mailing address
1793 13TH St SE
Salem, OR 97302-2541
Phone (503) 362-8385
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227660 | Medicaid | OR | |
| 271171 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR14081 | OR | MD | Allergy & Immunology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1366540742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1793 13TH ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973022541",
"telephone_number": "503-362-8385",
"fax_number": "503-362-8435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1793 13TH ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973022541",
"telephone_number": "503-362-8385",
"fax_number": "503-362-8435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "CHARLES",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "OR",
"license": "OR14081",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227660",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "271171",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.