NPIMap

Individual provider Active NPI

Melissa Anne Wagner, CRNP

  • Family Nurse Practitioner
  • Silverdale, PA
National Provider Identifier
1417598491
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP020001 Issued in PA
Practice address
164 West Main St
Silverdale, PA 18962
Phone
(215) 258-3810
Fax
(833) 616-9320
NPI assigned
Oct 1, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP020001 PA Primary

Addresses

Primary practice location

164 West Main St
Silverdale, PA 18962

Mailing address

164 West Main St
Silverdale, PA 18962
Phone (215) 258-3810

Other names 1

  • Melissa Anne Gonder Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20200331002083 PA Practitioner - Nurse Practitioner 3072942739 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1021 Park Ave
Quakertown, PA 18951-0130

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP020001PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kim Kuhar D O Internal Medicine P C CurrentSince Mar 1, 2022 Accepting new patients
St Luke'S Physician Group Inc CurrentSince Jan 1, 2026 Accepting new patients
St. Luke'S Physician Group, Inc. CurrentSince Jan 1, 2026 Accepting new patients
St. Luke'S Physician Group, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mwagner351058@direct-sluhn.org

Organizations & group practices 5

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1569888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1417598491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 WEST MAIN ST",
            "city": "SILVERDALE",
            "state": "PA",
            "postal_code": "18962",
            "telephone_number": "215-258-3810",
            "fax_number": "833-616-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 WEST MAIN ST",
            "city": "SILVERDALE",
            "state": "PA",
            "postal_code": "18962",
            "telephone_number": "215-258-3810",
            "fax_number": "833-616-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-01",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP020001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "GONDER",
            "middle_name": "ANNE",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Silverdale, PA

Sources for this page

Verify at the official NPI Registry.