NPIMap

Individual provider Active NPI

Michael Wagner, MD

  • Internal Medicine Physician
  • Medford, MA
National Provider Identifier
1437199437
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
72830 Issued in MA
Practice address
170 Governors Ave
Medford, MA 02155-1643
Phone
(508) 486-5678
NPI assigned
Jun 7, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 72830 MA Primary

Addresses

Primary practice location

170 Governors Ave
Medford, MA 02155-1643

Mailing address

13 Old Landing Rd
Pembroke, MA 02359-1948
Phone (214) 712-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20040806000403 MA Practitioner - Internal Medicine 1759353204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tufts Medical Center, Inc. Past Accepting new patients
New York Em-III Medical Services, PC Internal Medicine Past Accepting new patients
Tufts Medical Center Community Care, Inc Internal Medicine PastSince Jul 1, 2015 Accepting new patients
Tufts Medicine Care at Home, Inc. PastSince Oct 1, 2018 Accepting new patients
Massachusetts Em-1 Medical Services Past Accepting new patients
Aeger Inpatient Services Internal Medicine Past Accepting new patients
New York Em-III Medical Services, PC Internal Medicine Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kent County Memorial HospitalWarwick, RI, CCN 410009 Hospital Corporate Officer Jan 1, 2024
Kent County Memorial HospitalWarwick, RI, CCN 41T009 Hospital W-2 Managing Employee Jan 1, 2024
Women & Infants Hospital of Rhode IslandProvidence, RI, CCN 410010 Hospital Corporate Officer Dec 1, 2022
Vna of Care New EnglandWarwick, RI, CCN 417006A Home health agency Corporate Officer
W-2 Managing Employee		 Jan 1, 2026
Jan 1, 2026
Vna of Care New EnglandWarwick, RI, CCN 411505A Hospice Corporate Officer
W-2 Managing Employee		 Jan 1, 2024
Jan 1, 2024

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1437199437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 OLD LANDING RD",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023591948",
            "telephone_number": "214-712-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "508-486-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "72830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.