Active NPI
Brett Wagner
- Perfusionist
- Milwaukee, WI
National Provider Identifier
1578198461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 226-18
- Practice address
- 8701 W Watertown Plank Rd FL Hub5
Milwaukee, WI 53226-3548 - Phone
- (414) 955-6900
- Fax
- (414) 955-0079
- NPI assigned
- Mar 11, 2020
- Last updated
- Mar 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 226-18 | WI | Primary |
Addresses
Primary practice location
8701 W Watertown Plank Rd FL Hub5
Milwaukee, WI 53226-3548
Mailing address
836 S 86TH St
West Allis, WI 53214-2905
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 226-18 | WI | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1578198461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 S 86TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532142905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8701 W WATERTOWN PLANK RD FL HUB5",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263548",
"telephone_number": "414-955-6900",
"fax_number": "414-955-0079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "BRETT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-11",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "WI",
"license": "226-18",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.