Individual provider Active NPI

Edward Arthur Wagner, M.D.

  • Hematology & Oncology Physician
  • Laguna Hills, CA
National Provider Identifier
1487799474
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A61875 Issued in CA
Practice address
24411 Health Center Dr., Ste 510
Laguna Hills, CA 92653-3633
Phone
(949) 499-4540
Fax
(949) 499-4541
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X A61875 CA Primary

Addresses

Primary practice location

24411 Health Center Dr., Ste 510
Laguna Hills, CA 92653-3633

Mailing address

24411 Health Center Dr., Ste 510
Laguna Hills, CA 92653-3633
Phone (949) 499-4540

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20041101000504 CA Practitioner - Hematology/Oncology 1456313527 Reassigns benefits to 1 organization
Receives reassigned benefits from 1 practitioner
Practice locations: Laguna Niguel, CA

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
University of California, Irvine, California College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

23512 Madero
Mission Viejo, CA 92691-2743
Phone (949) 583-1600

24268 El Toro Rd
Laguna Woods, CA 92637-3435
Phone (657) 241-8455

24411 Health Ctr Dr
Laguna Hills, CA 92653-3633

24411 Health Ctr Dr
Suite 620
Laguna Hills, CA 92653-3672
Phone (657) 241-8270

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone (949) 459-9968

30492 Gateway PL
Suite 110
Rancho Mission Viejo, CA 92694-1862
Phone (657) 241-8435

4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-1723
Phone (949) 551-1090

722 Baker St
Costa Mesa, CA 92626-4320
Phone (714) 557-6300

Hospital & facility affiliations

  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603
  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A61875CAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation CurrentSince Jun 15, 2022 Accepting new patients
Laguna Beach Rehab, Inc. Past Accepting new patients
Laguna Beach Rehab Inc PastSince Jul 24, 2022 Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Bristol Park Medical Group, Inc Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

24411 Health Center Dr
Ste 510
Laguna Hills, CA 92653
Phone (949) 452-7515

24411 Health Center Dr
Ste 620
Laguna Hills, CA 92653
Phone (657) 241-8270

2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Practitioners & affiliated clinicians

Practitioners 1

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

Organizations & group practices 7

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 6

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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1487799474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24411 HEALTH CENTER DR., STE 510",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533633",
            "telephone_number": "949-499-4540",
            "fax_number": "949-499-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24411 HEALTH CENTER DR., STE 510",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533633",
            "telephone_number": "949-499-4540",
            "fax_number": "949-499-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "EDWARD",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A61875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

Verify at the official NPI Registry.