Neilson Lane Wagley, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30.026403 Issued in OH

Practice address

5437 Mahoning Ave
Austintown, OH 44515-2437

Phone

(330) 792-2501

NPI assigned

Apr 11, 2017

Last updated

Jun 14, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Maxillofacial SurgeryAlso: Oral Surgery

Education

Univ of Pittsburgh School of Dental Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mill Creek Oral and Maxillofacial Surgery Associates IncGroup PAC ID 8325205206, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mill Creek Oral & Maxillofacial Surgery Associates Inc

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Austintown, OH
  • NPI 1063549236

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Surgery Physician
  • Youngstown, OH
  • NPI 1649892225

  Single Specialty

  Medicare reassignment NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1386316107
  NPD

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

• Mercy Health Youngstown LLC

  dba Mercy Health St Elizabeth Youngstown Hospital

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  dba Mercy Health Youngstown Laboratory

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1427582964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5437 MAHONING AVE",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445152437",
            "telephone_number": "330-792-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5437 MAHONING AVE",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445152437",
            "telephone_number": "330-792-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGLEY",
        "first_name": "NEILSON",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-11",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "11222",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.026403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "11222",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "30.026403",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Wacht
• Nicholas Wade, CDCA
• Ashley Waggoner
• Renea Waggoner
• Craig A Wagley, DDS MD
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2063)
• Wal-Mart Stores East, LP (Vision Center 30-2063)
• Walgreen Co (Walgreens #06589)
• Chanda Denise Walker
• Colleen Wallace, DPT

• Oral and Maxillofacial Surgery (Dentist) in Austintown, OH
• Providers in Austintown, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.