Brian J Wagner, MD

Primary specialty

Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X

License

225630 Issued in NY

Practice address

1176 Fifith Avenue E Level
New York, NY 10029-6501

Phone

(212) 659-8557

Fax

(212) 369-2385

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Obstetrics/Gynecology

Education

University of North Dakota School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: bwagner143164@direct.optum.com

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.

• Optum Medical Care, P.C.

  • Cardiovascular Disease Physician
  • Mount Kisco, NY
  • NPI 1982643003
  Medicare reassignment Care Compare group NPD
• Icahn School of Medicine at Mount Sinai

  • Obstetrics & Gynecology Physician
  • New York, NY
  • NPI 1124392212
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  • Obstetrics & Gynecology Physician
  • New York, NY
  • NPI 1922411065
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• Optum Medical Care, P.C.

  • Durable Medical Equipment & Medical Supplies
  • New Hyde Park, NY
  • NPI 1053190595
  NPD
• Mount Kisco Medical Group

  • Hematology (Internal Medicine) Physician
  • Fishkill, NY
  • NPI 1952356362

  Obstetrics & Gynecology

  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1477633931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 EAST 98TH STREET BOX 1170",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296501",
            "telephone_number": "212-241-5681",
            "fax_number": "212-348-7438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 FIFITH AVENUE E LEVEL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296501",
            "telephone_number": "212-659-8557",
            "fax_number": "212-369-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRIAN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "225630",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "NY",
            "license": "225630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02532754",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anju Wagh, MD
• Jenna Michelle Wagman, MS, OTR/L
• Aleksandra Wagner, LP
• Ariel Wagner, LMSW
• Ashley Elizabeth Wagner, FNP
• Daniel Wagner, LISW
• Elise Melanie Wagner, MS, CCC-SLP
• Emily Brasco Wagner, PA-C
• Frank Douglas Wagner, MA, CMT, NRMT, LCAT
• Ira J Wagner, M.D.

• Maternal & Fetal Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Maternal & Fetal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; 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.