NPIMap

Organization Active NPI

Laura Wagner, Inc

  • Specialist
  • Saint Peters, MO
National Provider Identifier
1487801635
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
R8N01 Issued in MO
Legal business name
LAURA WAGNER, INC
Practice address
6 Jungermann Cir
Suite 211
Saint Peters, MO 63376-1621
Phone
(636) 926-7938
Fax
(636) 926-2286
NPI assigned
Aug 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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

Authorized official

Name
Laura Ella Wagner, M.D.NPI 1669445060
Title
President
Phone
(636) 926-8554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X R8N01 MO Primary

Addresses

Primary practice location

6 Jungermann Cir
Suite 211
Saint Peters, MO 63376-1621

Mailing address

PO Box 790379
Saint Louis, MO 63179-0379
Phone (636) 926-7938

Other identifiers 6

IdentifierTypeStateIssuer
00004839OtherMOMEDICARE PTAN #
211386OtherMOHEALTHLINK ID#
4420124OtherMOAETNA PROVIDER #
39228V39228OtherMOGHP PROVIDER #
1669445060OtherMOTYPE 1 NPI
18374OtherMOBCBSMO PROVIDER#

National Provider Directory

National Provider Directory
Tax ID family
Laura Wagner Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEIBBD
  • FHIR API: https://api.platform.athenahealth.com/14699/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1487801635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790379",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790379",
            "telephone_number": "636-926-7938",
            "fax_number": "636-926-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 JUNGERMANN CIR",
            "address_2": "SUITE 211",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761621",
            "telephone_number": "636-926-7938",
            "fax_number": "636-926-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA WAGNER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ELLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-926-8554",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "R8N01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "00004839",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK ID#",
            "identifier": "211386",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "4420124",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP PROVIDER #",
            "identifier": "39228V39228",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1669445060",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMO PROVIDER#",
            "identifier": "18374",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.