NPIMap

Individual provider Active NPI

Benjamin Lee Wagenman, MD

  • Clinical Pathology Physician
  • Albuquerque, NM
National Provider Identifier
1467636951
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
MD2011-0037 Issued in NM
Practice address
1100 Central Ave SE
PHS- Lab - S1 Level
Albuquerque, NM 87106-4930
Phone
(505) 841-1330
NPI assigned
Dec 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology Physician 207ZC0006X MD2011-0037 NM Primary

Addresses

Primary practice location

1100 Central Ave SE
PHS- Lab - S1 Level
Albuquerque, NM 87106-4930

Mailing address

1100 Central Ave SE
PHS- Lab - S1 Level
Albuquerque, NM 87106-4930
Phone (505) 841-1330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110401000514 NM Practitioner - Pathology 0446305866 Reassigns benefits to 2 organizations
I20240129001103 MO Practitioner - Pathology 0446305866 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Medical College of Wisconsin, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Unm Medical Group, Inc. CurrentSince Feb 10, 2011 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Dec 23, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Dec 23, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Dec 23, 2023 Accepting new patients
Presbyterian Healthcare Services CurrentSince Feb 15, 2011 Accepting new patients
Presbyterian Healthcare Services CurrentSince Feb 15, 2011 Accepting new patients
Presbyterian Healthcare Services Current Accepting new patients
Unm Medical Group Inc CurrentSince Feb 10, 2011 Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

1100 Central Ave SE
#S1
Albuquerque, NM 87106
Phone (505) 841-1330

8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200

2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141

1010 Spruce St
Espanola, NM 87532
Phone (505) 367-0340

211 Sudderth Dr
Ruidoso, NM 88345
Phone (505) 257-7381

4801 Beckner Rd
Santa Fe, NM 87507
Phone (505) 772-1234

1202 Highway 60
Socorro, NM 87801
Phone (505) 835-1140

301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

Interoperability endpoints

  • Direct secure messaging: bwagenman11736@ahs.direct-ci.com

Organizations & group practices 8

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 9

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": "1198108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353888000000",
    "number": "1467636951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 CENTRAL AVE SE",
            "address_2": "PHS- LAB - S1 LEVEL",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064930",
            "telephone_number": "505-841-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CENTRAL AVE SE",
            "address_2": "PHS- LAB - S1 LEVEL",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064930",
            "telephone_number": "505-841-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENMAN",
        "first_name": "BENJAMIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-20",
        "last_updated": "2012-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "NM",
            "license": "MD2011-0037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.