Alan S. Wagner, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

36-099687 Issued in IL

Practice address

3849 N Perryville Rd
Rockford, IL 61114-8080

Phone

(815) 397-5554

Fax

(866) 914-7534

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Camelot Imaging Solutions, LTD

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Rockford, IL
  • NPI 1861836835
  NPD (past)
• Summit Radiology, LLC

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1811401284
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1497701684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3849 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148080",
            "telephone_number": "815-397-5554",
            "fax_number": "866-914-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3849 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148080",
            "telephone_number": "815-397-5554",
            "fax_number": "866-914-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ALAN",
        "middle_name": "S.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "36-099687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099687",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn J Vranek, LCSW
• Monesa Catherine Vu, PHARMD
• Michelle Vurnovas, LCSW
• Erin J Wade, PH.D.
• Wagner Counseling PLLC Samantha Wagner Sole MBR
• Natalie J Wagner, OT
• Peggy Lynn Wagner, APN
• Samantha Wagner
• Samantha Elizabeth Wagner, APRN
• Patti J Wakefield, PT

• Diagnostic Radiology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; 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.