Active NPI
James A Wagner, CADCIII-RCS
- Addiction (Substance Use Disorder) Counselor
- Racine, WI
National Provider Identifier
1376718288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 10328
- Practice address
- 524 Main Street
Suite 302
Racine, WI 53403-1032 - Phone
- (262) 632-1780
- Fax
- (262) 632-0895
- NPI assigned
- Apr 23, 2008
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 10328 | WI | Primary |
Addresses
Primary practice location
524 Main Street
Suite 302
Racine, WI 53403-1032
Mailing address
524 Main Street
Suite 302
Racine, WI 53403-1032
Phone (262) 632-1780
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39172800 | Medicaid | WI |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zimmerman Consulting Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Racine, WI
- NPI 1982877486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208908800000",
"number": "1376718288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "524 MAIN STREET",
"address_2": "SUITE 302",
"city": "RACINE",
"state": "WI",
"postal_code": "534031032",
"telephone_number": "262-632-1780",
"fax_number": "262-632-0895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "524 MAIN STREET",
"address_2": "SUITE 302",
"city": "RACINE",
"state": "WI",
"postal_code": "534031032",
"telephone_number": "262-632-1780",
"fax_number": "262-632-0895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JAMES",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "CADCIII-RCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-23",
"last_updated": "2008-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "10328",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39172800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.