Mary K. Wagner, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD60167561 Issued in WA

Practice address

1414 N Vercler Rd
Building 1
Spokane Valley, WA 99216-1092

Phone

(509) 928-6383

Fax

(509) 926-9420

NPI assigned

Aug 18, 2005

Last updated

Jul 29, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Metropolitan Pediatrics, LLC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1235131632
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1427040203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER RD",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER RD",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARY",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60167561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanay Elizabeth Wachtel, MSW, LICSW
• Maggie Wadsworth
• Emmalee Marian Wagley, DPT
• Gary L. Wagner, CRNA
• Kai Jonathan Wagner
• Joshua Wahl
• Wal-Mart Stores, Inc (Vision Center 30-2539)
• Charles Walden
• Walgreen Co (Walgreens #05914)
• Walgreen Co (Walgreens #01993)

• Pediatrics Physician in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.