Samantha Wagoner, QMHS3YRS CMS

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2207212 Issued in OH

Practice address

3500 Carnegie Ave
Cleveland, OH 44115-2641

Phone

(440) 260-8300

NPI assigned

May 26, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1437724937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22001 FAIRMOUNT BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441184819",
            "telephone_number": "216-320-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152641",
            "telephone_number": "440-260-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "SAMANTHA",
        "credential": "QMHS3YRS CMS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2207212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Wagner, RPH
• Monique J Wagner
• Patty Wagner
• Paul Wagner, RBT
• Tamara Wagner
• Penina Sarah Wagschal-Weiss
• Eisheh Wahdan
• Rehan Waheed, M.D.
• Steve Wainkroot, LMT
• Rebecca L Wainwright, CNP

• Social Worker in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.