Individual provider Active NPI

Tamara W. Wager

  • Local Education Agency (LEA)
  • East Greenbush, NY
National Provider Identifier
1538445291
Registry record updated Oct 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Local Education Agency (LEA)Taxonomy code 251300000X
Practice address
962 Luther Rd
East Greenbush, NY 12061-4015
Phone
(518) 207-2065
Fax
(518) 207-2069
NPI assigned
Oct 26, 2011
Last updated
Oct 26, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Local Education Agency (LEA) 251300000X Primary

Addresses

Primary practice location

962 Luther Rd
East Greenbush, NY 12061-4015

Mailing address

962 Luther Rd
East Greenbush, NY 12061-4015
Phone (518) 207-2065

Other identifiers 1

IdentifierTypeStateIssuer
01409145MedicaidNY

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)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
East Greenbush Central School District Local Education Agency (Lea) Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1538445291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "962 LUTHER RD",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120614015",
            "telephone_number": "518-207-2065",
            "fax_number": "518-207-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "962 LUTHER RD",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120614015",
            "telephone_number": "518-207-2065",
            "fax_number": "518-207-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGER",
        "first_name": "TAMARA",
        "middle_name": "W.",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-26",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01409145",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Greenbush, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.