Mark W Wagner, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

15073 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425-0001

Phone

(843) 792-1414

NPI assigned

Aug 29, 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

Enrolled in NH

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

Specialty

Psychiatry

Education

University of Cincinnati College of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Lakes Region Mental Health Center, Inc 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• The Lakes Region Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Laconia, NH
  • NPI 1902994866

  NH

  Medicare reassignment Care Compare group NPD
• Concord Hospital-Laconia

  • Family Medicine Physician
  • Laconia, NH
  • NPI 1053993741

  NH

  Medicare reassignment NPD
• Lrghealthcare

  • Family Medicine Physician
  • Laconia, NH
  • NPI 1700976032

  NH

  Medicare reassignment NPD
• Speare Memorial Hospital

  • General Practice Physician
  • Plymouth, NH
  • NPI 1346402047

  NH

  Medicare reassignment NPD
• Speare Memorial Hospital

  • Emergency Medicine Physician
  • Plymouth, NH
  • NPI 1346487956
  NPD
• Speare Memorial Hospital

  • Family Medicine Physician
  • Meredith, NH
  • NPI 1669161659
  NPD
• Healthfirst Family Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Laconia, NH
  • NPI 1972203347
  NPD (past)

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1508974544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294250001",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "15073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150739",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara S Wagner, LPC
• Carol L Wagner, MD
• Janelle L Wagner, PHD
• Jessee Davis Wagner
• Mark T Wagner, PHD
• Krista Terese Wagoner, M.D.
• Carolyn Friedland Wahl, NP-C
• Maya Hadas Wahl, PA-C
• Cayla Ellen Wakser, MD
• Wal-Mart Stores East LP

• All providers in Charleston, SC
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.