Active NPI
Wayne S Wahl, M.D.
- Family Medicine Physician
- Rose City, MI
National Provider Identifier
1619928579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301039553
- Practice address
- 2990 Campbell Rd
Rose City, MI 48654-9724 - Phone
- (989) 685-2333
- Fax
- (989) 685-2760
- NPI assigned
- May 15, 2006
- Last updated
- Jan 8, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301039553 | MI | Primary |
Addresses
Primary practice location
2990 Campbell Rd
Rose City, MI 48654-9724
Mailing address
2990 Campbell Rd
PO Box 527
Rose City, MI 48654-9724
Phone (989) 685-2333
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08OG21014 | Other | MI | BCBS |
| 4737446 | Medicaid | MI | |
| 4737400 | Medicaid | MI | |
| 4737419 | Medicaid | MI | |
| 4758858 | Medicaid | MI | |
| P00258733 | Other | MI | RAILROAD MEDICARE |
| 4758830 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199750400000",
"number": "1619928579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2990 CAMPBELL RD",
"address_2": "PO BOX 527",
"city": "ROSE CITY",
"state": "MI",
"postal_code": "486549724",
"telephone_number": "989-685-2333",
"fax_number": "989-685-2760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2990 CAMPBELL RD",
"city": "ROSE CITY",
"state": "MI",
"postal_code": "486549724",
"telephone_number": "989-685-2333",
"fax_number": "989-685-2760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHL",
"first_name": "WAYNE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2008-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301039553",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "08OG21014",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4737446",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4737400",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4737419",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4758858",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00258733",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4758830",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rose City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.