NPIMap

Individual provider Active NPI

Kristin Elizabeth Wagner, M.D.

  • Surgery Physician
  • Charlotte, NC
National Provider Identifier
1518943166
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
200301072 Issued in NC
Practice address
1918 Randolph Rd Ste 300
Charlotte, NC 28207-1112
Phone
(704) 333-0741
Fax
(704) 333-3356
NPI assigned
Dec 15, 2005
Last updated
Nov 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 200301072 NC Primary

Addresses

Primary practice location

1918 Randolph Rd Ste 300
Charlotte, NC 28207-1112

Mailing address

PO Box 604350
Charlotte, NC 28260-4350

Other identifiers 1

IdentifierTypeStateIssuer
891345GMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040731000283 NC Practitioner - General Surgery 8527038918 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Temple University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Prep II LLCGroup PAC ID 1052835311, 47 clinicians

Practice addresses (Care Compare)

7300 Carmel Executive Park Dr
Suite 200
Charlotte, NC 28226-1336
Phone (704) 364-8104

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy1-10
Hernia repair - groin (open)1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Prep II LLC Surgery CurrentSince Apr 1, 2025 Accepting new patients
Novant Health Prep II LLC Surgery CurrentSince Apr 1, 2025 Accepting new patients
Novant Health Prep II LLC Surgery Current Accepting new patients
Cleveland Clinic Florida a Nonprofit Corporation Past Accepting new patients
Charlotte Trauma Services, PLLC Past Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Past Accepting new patients
The Cleveland Clinic Foundation Past Accepting new patients

Locations

10320 Mallard Creek Rd
Ste 100
Charlotte, NC 28262
Phone (704) 547-9500

10512 Park Rd
Ste 101
Charlotte, NC 28210
Phone (704) 339-1076

1918 Randolph Rd
Ste 300
Charlotte, NC 28207
Phone (704) 333-0741

2001 Vail Ave
Ste 320
Charlotte, NC 28207
Phone (704) 333-0741

7300 Carmel Executive Park Dr
Ste 200
Charlotte, NC 28226
Phone (704) 364-8100

8201 Healthcare Loop
Ste 202
Charlotte, NC 28215
Phone (704) 316-1120

10030 Gilead Rd
Ste 245
Huntersville, NC 28078
Phone (704) 895-9390

1450 Matthews Township Pkwy
Ste 250
Matthews, NC 28105
Phone (704) 841-1444

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1518943166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071112",
            "telephone_number": "704-333-0741",
            "fax_number": "704-333-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KRISTIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-15",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "200301072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891345G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.