Individual provider Active NPI

Desiree Nicole Mohney, MD

  • Pediatrics Physician
  • Rochester, NY
National Provider Identifier
1558756247
Registry record updated Jul 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
317188 Issued in NY
Practice address
601 Elmwood Ave
Rochester, NY 14642-0001
Phone
(585) 276-4113
Fax
(570) 808-6072
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD463914 PA
Medical Physician Assistant 363AM0700X 317188 NY
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 317188 NY Primary

Addresses

Primary practice location

601 Elmwood Ave
Rochester, NY 14642-0001

Mailing address

601 Elmwood Ave Box 635
Rochester, NY 14642-0001
Phone (585) 276-4113

Other names 1

  • Dr. Desiree Nicole Wagner Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dwagner74847@direct.urmc.rochester.edu Direct
Direct Messaging Address dwagner74847@direct.urmc.rochester.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180719000145 PA Practitioner - Pediatric Medicine 3274880471 Reassigns benefits to 1 organization
I20220815000944 NY Practitioner - Pediatric Medicine 3274880471 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
317188NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Group Univ of Rochester Pediatrics CurrentSince Sep 1, 2022 Accepting new patients
Pediatric Group Univ of Rochester CurrentSince Sep 1, 2022 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jul 16, 2018 Accepting new patients
University of Rochester Past Accepting new patients

Locations

601 Elmwood Ave
#635
Rochester, NY 14642
Phone (585) 275-2821

601 Elmwood Ave
#320
Rochester, NY 14642

601 Elmwood Ave
#777
Rochester, NY 14642
Phone (585) 275-0995

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

100 N Academy Ave
Danville, PA 17822

1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689984000000",
    "number": "1558756247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE BOX 635",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-276-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-276-4113",
            "fax_number": "570-808-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHNEY",
        "first_name": "DESIREE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2023-07-22",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD463914",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "317188",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "317188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwagner74847@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwagner74847@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DESIREE",
            "last_name": "WAGNER",
            "middle_name": "NICOLE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.