Active NPI
John G Wagner, M.D.
- Pulmonary Disease Physician
- Pensacola, FL
National Provider Identifier
1528043536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- ME0076654
- Practice address
- 5149 N 9TH Ave
Suite 120
Pensacola, FL 32504-8734 - Phone
- (850) 477-9253
- Fax
- (850) 494-9843
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | ME0076654 | FL | |
| Pulmonary Disease Physician | 207RP1001X | ME0076654 | FL | Primary |
Addresses
Primary practice location
5149 N 9TH Ave
Suite 120
Pensacola, FL 32504-8734
Mailing address
5149 N 9TH Ave
Suite 120
Pensacola, FL 32504-8734
Phone (850) 477-9253
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 254788100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0076654 | FL | MD | Critical Care Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302480000000",
"number": "1528043536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5149 N 9TH AVE",
"address_2": "SUITE 120",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325048734",
"telephone_number": "850-477-9253",
"fax_number": "850-494-9843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5149 N 9TH AVE",
"address_2": "SUITE 120",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325048734",
"telephone_number": "850-477-9253",
"fax_number": "850-494-9843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JOHN",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2011-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "FL",
"license": "ME0076654",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "FL",
"license": "ME0076654",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "254788100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.