Individual provider Active NPI

Jordan Wagner, D.O.

  • Emergency Medicine Physician
  • Cambridge, MA
National Provider Identifier
1558590679
Registry record updated Sep 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A14140 Issued in CA
Practice address
1493 Cambridge St
Cambridge, MA 02139-1047
Phone
(617) 665-1435
NPI assigned
Jul 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 249402 MA
Emergency Medicine Physician 207P00000X 20A14140 CA Primary

Addresses

Primary practice location

1493 Cambridge St
Cambridge, MA 02139-1047

Mailing address

1493 Cambridge St
Cambridge, MA 02139-1047
Phone (617) 665-1435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20151008002482 CA Practitioner - Emergency Medicine 9537300686 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of New England, College of Osteo Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, shared by 2 NPIs, 1,278 clinicians

Practice addresses (Care Compare)

1141 Rose Ave
Selma, CA 93662-3241
Phone (559) 891-1000

1798 N Garey Ave
Pomona, CA 91767-2918
Phone (909) 865-9500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A14140CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palomar Emergency Physicians, Inc Emergency Medicine CurrentSince Oct 28, 2021 Accepting new patients
Montclair Emergency Medical Associates Emergency Medicine CurrentSince Dec 1, 2018 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Alvarado Emergency Medical Associates, Inc. Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

2185 Citracado Pkwy
Escondido, CA 92029
Phone (442) 281-5000

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

5000 San Bernardino St
Montclair, CA 91763
Phone (909) 625-4111

15615 Pomerado Rd
Poway, CA 92064
Phone (858) 613-4000

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

1141 Rose Ave
Selma, CA 93662
Phone (559) 790-2800

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1558590679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JORDAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-10",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "249402",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A14140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.