Jack Wagoner, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

4301-407025 Issued in MI

Practice address

205 N East Ave
Jackson, MI 49201-1753

Phone

(517) 788-4963

Fax

(517) 789-5903

NPI assigned

Jun 18, 2006

Last updated

Nov 6, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Anesthesiology

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chelsea Hospital Hospital, Chelsea, MI, CCN 230259
• Forest Health Medical Center Hospital, Ypsilanti, MI, CCN 230144
• University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Merit-based Incentive Payment System (MIPS)

Final score

67.5 of 100Reported as group

Quality

58.12

Improvement activities

40

Cost

68.45

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anesthesia Associates of Ann Arbor, PLLC

  • Anesthesiology Physician
  • Westland, MI
  • NPI 1669581997
  Medicare reassignment Care Compare group NPD
• Anesthesia Associates at Foote Hospital, PC

  • Anesthesiology Physician
  • Jackson, MI
  • NPI 1033152376
  NPD (past)

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

• Forest Health Medical Center LLC

  dba Forest Health Medical Center

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1669493664
  Care Compare affiliation
• Regents of the University of Michigan

  dba University of Michigan Health System

  • General Acute Care Hospital
  • Ann Arbor, MI
  • NPI 1003878539
  Care Compare affiliation
• St Joseph Mercy Chelsea Inc

  dba Chelsea Hospital

  • General Acute Care Hospital
  • Chelsea, MI
  • NPI 1992761985
  Care Compare affiliation

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194307200000",
    "number": "1598700072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4963",
            "fax_number": "517-789-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4963",
            "fax_number": "517-789-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2007-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301-407025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Wade
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• Anish Wadhwa, M.D.
• Meghan Waggoner
• Ronald Paul Wagner, PA-C
• Susan Marie Waite, NBC-HIS
• Wal-Mart Stores East , LP (Walmart Pharmacy 10-5160)
• Wal-Mart Stores East, LP (Vision Center 30-5160)
• John Joseph Wald, M.D.
• Audrey Waldo

• Anesthesiology Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.