Catherine Y.H. Wagoner, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD171324 Issued in OR

Practice address

9290 SE Sunnybrook Blvd Ste 120
Clackamas, OR 97015-6802

Phone

(503) 215-2110

NPI assigned

Feb 9, 2006

Sex

Female

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwagoner1011267@oc.providencedirect.org

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.

• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• Providence Health & Services Oregon

  • Interventional Cardiology Physician
  • Portland, OR
  • NPI 1386956621
  NPD
• Providence Health & Services Oregon

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD
• Brown, Calvanese, Cameron LTD

  • Emergency Medicine Physician
  • Reno, NV
  • NPI 1275568479
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1487627550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9290 SE SUNNYBROOK BLVD STE 120",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156802",
            "telephone_number": "503-215-2110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10581 Double R Blvd",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "89511",
            "country_code": "US",
            "telephone_number": "775-324-0766",
            "fax_number": "775-324-0788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "CATHERINE",
        "middle_name": "Y.H.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "9839",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD171324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002016768",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwagoner1011267@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9290 SE Sunnybrook Blvd Ste 120",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970156802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Benjamin Daniel Wachsmuth, M.D.
• Steven H Wacker
• Megan Jean Wackford
• Leland Spencer Waddoups, PHARMD
• Matthew Dale Wagner, M.D.
• Jennifer Josephine Walker-Kinde, D.O
• Bernadette Walker, PHARM.D.
• David Kenneth Walker, DMD
• Erin J Walker, PT
• Johnny Corrace Walker, M.S.S.W.

• Pediatrics Physician in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.