Individual provider Active NPI

Ira J Wagner, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • New York, NY
National Provider Identifier
1619909512
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
131401 Issued in NY
Practice address
St Vincents Hospital 153 West 11TH Street
New York, NY 10011
Phone
(212) 604-8336
Fax
(212) 604-8061
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 131401 NY Primary

Addresses

Primary practice location

St Vincents Hospital 153 West 11TH Street
New York, NY 10011

Mailing address

222 W 14TH St
New York, NY 10011-7200
Phone (212) 604-1824

Other identifiers 2

IdentifierTypeStateIssuer
CF6456OtherNYRAILROAD MEDICARE
00599500MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20041111001034 NY Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 7517921315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
State University of New York Downstate Medical Center, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850

111 E 77TH St
New York, NY 10075-1850
Phone (212) 434-3966

1111 Marcus Ave
New Hyde Park, NY 11042-1034

122 E 76TH St
New York, NY 10021-2833

130 E 77TH St
New York, NY 10075-1851

300 Community Dr
Manhasset, NY 11030-3816

300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229

330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550

350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845

972 Brush Hollow Rd
Westbury, NY 11590-1740
Phone (516) 876-4100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
MJM Medicine PLLC Critical Care Medicine Past Accepting new patients
Lenox Hill Hospital Past Accepting new patients
Park Lenox Medical, PC Critical Care Medicine Past Accepting new patients
Christopher M. Dixon, M.D. PLLC Past Accepting new patients
St Vincents Hospital and Medical Center Past Accepting new patients
Greenbaum, MD - Wagner, MD Critical Care Medicine Past Accepting new patients

Locations

1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242

122 E 76th St
New York, NY 10021
Phone (212) 434-2878

100 E 77th St
Fl 4
New York, NY 10075
Phone (212) 434-6300

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

201 E 19th St
Lbby 1
New York, NY 10003
Phone (212) 673-7300

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: iwagner66672@northwell.direct-ci.com

Organizations & group practices 7

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 11

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1619909512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W 14TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100117200",
            "telephone_number": "212-604-1824",
            "fax_number": "212-604-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ST VINCENTS HOSPITAL 153 WEST 11TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10011",
            "telephone_number": "212-604-8336",
            "fax_number": "212-604-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "IRA",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "131401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF6456",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00599500",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.