Ethan E Wagner, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

02002898A Issued in IN

Practice address

2015 Jackson St
Anderson, IN 46016-4337

Phone

(765) 646-8439

Fax

(765) 646-8578

NPI assigned

Jul 20, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Emergency Medicine

Education

R Franklin University of Med & Sci/Chicago Medical School, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverview HospitalGroup PAC ID 1153216627, 209 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverview Health Hospital, Noblesville, IN, CCN 150059

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as apm

Quality

80.38

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Riverview Hospital

  • Family Medicine Physician
  • Noblesville, IN
  • NPI 1609074921

  Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Emergency Professionals of Indiana, P.C.

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1013951219
  Medicare reassignment NPD
• Lafayette Emergency Care, P.C.

  • Emergency Medicine Physician
  • Lafayette, IN
  • NPI 1861447211
  Medicare reassignment NPD
• Riverview Hospital

  • General Acute Care Hospital
  • Noblesville, IN
  • NPI 1225275928
  NPD
• Riverview Hospital

  • Skilled Nursing Facility
  • Indianapolis, IN
  • NPI 1831164995
  NPD
• Emergency Physicians of Delaware County, P.C.

  • Emergency Medicine Physician
  • Muncie, IN
  • NPI 1417956384
  NPD (past)
• St. Vincent Anderson Regional Hospital, Inc.

  • General Acute Care Hospital
  • Anderson, IN
  • NPI 1679578850

  Emergency Medicine

  NPD (past)
• Samaritan Emergency Corp

  • Emergency Medicine Physician
  • Dayton, OH
  • NPI 1922084136
  NPD (past)

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

• Riverview Hospital

  • General Acute Care Hospital
  • Noblesville, IN
  • NPI 1700883717
  Care Compare affiliation

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1386643310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 JACKSON ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164337",
            "telephone_number": "765-646-8439",
            "fax_number": "765-646-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 JACKSON ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164337",
            "telephone_number": "765-646-8439",
            "fax_number": "765-646-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ETHAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02002898A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS /ANTHEM",
            "identifier": "000000514519",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miranda Michelle Wafford, RBT
• Marcus Jackson Wager, R.N.
• Madeline Wages-Hay
• Tony Shaun Wagler, O,D.
• Ching-Shu Wagner, D.D.S.
• Martin D Wagner, MD
• Satomi Wakabayashi, LMHC
• Khalil G Wakim
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP

• Emergency Medicine Physician in Anderson, IN
• Providers in Anderson, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.