Lynn Clark Vanwagnen, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301038051 Issued in MI

Practice address

1310 Greenwood Ave
Jackson, MI 49203-3077

Phone

(517) 787-1990

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Internal Medicine

Education

Wayne State University School of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, shared by 11 NPIs, 476 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Jackson, MI, CCN 237274
• Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092
• Chelsea Hospital Hospital, Chelsea, MI, CCN 230259

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lvanwagnen445636@direct.hfhs.org

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.

• Lynn Van Wagnen MD PC

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1396973129
  Medicare reassignment NPD Authorized official
• W. a. Foote Memorial Hospital, Inc

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1760437826
  Medicare reassignment NPD
• Wa Foote Memorial Hospital, Inc

  • Nurse Practitioner
  • Jackson, MI
  • NPI 1629000708
  Medicare reassignment NPD
• Wa Foote Memorial Hospital, Inc

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1831123728
  Medicare reassignment NPD
• W.a. Foote Memorial Hospital, Inc

  • Physician Assistant
  • Jackson, MI
  • NPI 1538606348
  NPD
• W.a. Foote Memorial Hospital, Inc

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1699212803
  NPD
• Wa Foote Memorial Hospital Inc.

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1083971477
  NPD

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

• Great Lakes Home Health Services, Inc.

  • Home Health Agency
  • Jackson, MI
  • NPI 1588642110
  Care Compare affiliation
• St Joseph Mercy Chelsea Inc

  • General Acute Care Hospital
  • Chelsea, MI
  • NPI 1992761985
  Care Compare affiliation
• W.a. Foote Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MI
  • NPI 1053403402
  Care Compare affiliation

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1609833359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 GREENWOOD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033077",
            "telephone_number": "517-787-1990",
            "fax_number": "517-787-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 GREENWOOD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033077",
            "telephone_number": "517-787-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWAGNEN",
        "first_name": "LYNN",
        "middle_name": "CLARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301038051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110241201",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101587882",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karli Jo Vanryswyk
• Timothy Scott Vanschoick, M.D.
• Beth Sue Vansumeren
• Aaron Michael Vanwagnen, MD
• Lenae E Vanwagnen, M.D.
• Richard J Vanwagoner, LBSW
• Tracy Dawn Vanwoert, MASSAGE THERAPIST
• Jonathon Walter Vargo, MD
• Amy Jean Varner, OTR/L
• Unknown Varsha, M.D.

• Internal Medicine Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.