Amy L Wagoner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

8597 Issued in SD

Practice address

901 4TH St NW
Watertown, SD 57201-1558

Phone

(605) 886-8471

Fax

(605) 886-9317

NPI assigned

Aug 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Sanford School of Medicine of University of South Dakota, 1997

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Milbank Area Hospital/Avera Health Hospital, Milbank, SD, CCN 431326
• Prairie Lakes Healthcare System, Inc Hospital, Watertown, SD, CCN 430005
• Ortonville Area Health Services Hospital, Ortonville, MN, CCN 241342

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Root Function Wellness PLLC

  • Primary Care Clinic/Center
  • Watertown, SD
  • NPI 1437629128
  Medicare reassignment NPD Authorized official
• Sanford Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254
  Medicare reassignment NPD
• Sanford Medical Center

  • Rural Health Clinic/Center
  • Clark, SD
  • NPI 1699755413
  NPD
• Sanford Clinic

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD
• Aspirus Medford Hospital & Clinics, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Medford, WI
  • NPI 1427105923
  NPD (past)

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

• Avera McKennan

  • Critical Access Hospital
  • Milbank, SD
  • NPI 1548272818
  Care Compare affiliation
• Avera McKennan

  • Rural Health Clinic/Center
  • Milbank, SD
  • NPI 1750488730

  Hospital

  Care Compare affiliation
• Ortonville Area Health Services

  • Critical Access Hospital
  • Ortonville, MN
  • NPI 1790783587
  Care Compare affiliation

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1376554568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 4TH ST NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011558",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "40276",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "8597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32585100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael J Vener, MD
• Jillian M Viessman
• Andrea Michelle Vosberg, MA, CCC-SLP
• Henry P Voss, CRNA
• W-J Optical
• Wal-Mart Stores, Inc.
• Walgreen Co
• Julia Walker
• Walmart Inc.
• Kaylin Wanna

• Family Medicine Physician in Watertown, SD
• Providers in Watertown, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; 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.