Robert Wagmeister M D a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G41624 Issued in CA

Legal business name

ROBERT WAGMEISTER M D A MEDICAL CORPORATION

Practice address

2001 Santa Monica Blvd Ste 670W
Santa Monica, CA 90404-2185

Phone

(310) 828-5626

Fax

(310) 828-2826

NPI assigned

Dec 8, 2006

Organization subpart

No

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

Authorized official

Name

Twila Marie Balara

Title

Office Manager

Phone

(310) 828-5626

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Wagmeister, M.D.

  • Specialist
  • Santa Monica, CA
  • NPI 1720014525
  Medicare reassignment

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1487713830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD STE 670W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042185",
            "telephone_number": "310-828-5626",
            "fax_number": "310-828-2826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD STE 670W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042185",
            "telephone_number": "310-828-5626",
            "fax_number": "310-828-2826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT WAGMEISTER M D A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "BALARA",
        "authorized_official_first_name": "TWILA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "310-828-5626"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G41624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G416240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juan Rivera
• RM Medical Sales LLC
• Robert Amonic, M.D., Inc.
• Robert E. Klenck M.D. Inc.
• Robert L. Portillo, D.P.M., Inc
• Jenna Roberts, MD
• Monise Agnes Ruby Roberts
• Stacy Roberts, MSW
• Dominique L Robertson, MFT PSYD
• John Marshall Robertson, MD

• Specialist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.