Jesse Wagner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036836 Issued in CT

Practice address

28 Crescent St
Middletown, CT 06457-3654

Phone

(860) 358-4720

Fax

(860) 358-6271

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Middlesex Hospital

  • Family Nurse Practitioner
  • Middletown, CT
  • NPI 1972563138

  CT, Internal Medicine

  Medicare reassignment NPD
• Connecticut Pathology Group PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Middletown, CT
  • NPI 1740219625
  NPD
• Middlesex Hospital

  • Community Based Hospice Care Agency
  • Middletown, CT
  • NPI 1003873233
  NPD
• Middlesex Hospital

  • Psychiatry Physician
  • Middletown, CT
  • NPI 1760451041
  NPD
• Middlesex Hospital

  • General Acute Care Hospital
  • Middletown, CT
  • NPI 1760454334
  NPD
• Middlesex Hospital

  • Family Medicine Physician
  • Middletown, CT
  • NPI 1851350664
  NPD

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257897600000",
    "number": "1528048428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-4720",
            "fax_number": "860-344-6271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-4720",
            "fax_number": "860-358-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2009-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "036836",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "036836",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Stephen Volpini, CADC
• Priti B Vyas, M.D.
• Whitney Lynn Wachtarz
• Wadsworth Glen, Inc
• Garrett Wayne Wadsworth, PT, DPT
• Rebecca Wahl, MD
• Craig Walden, MD
• Susan E Waldman, LADC
• Walgreen Co
• Walgreen Co

• Internal Medicine Physician in Middletown, CT
• Providers in Middletown, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.