Individual provider Active NPI

Richard Alan Wagner, M.D.

  • Family Medicine Physician
  • Evansville, IN
National Provider Identifier
1619973179
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01025468 Issued in IN
Practice address
4501 N 4TH Ave
Evansville, IN 47710-3529
Phone
(812) 422-7212
Fax
(812) 422-7326
NPI assigned
Jun 21, 2005
Last updated
Jan 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01025468 IN Primary

Addresses

Primary practice location

4501 N 4TH Ave
Evansville, IN 47710-3529

Mailing address

4501 N 4TH Ave
Evansville, IN 47710-3529
Phone (812) 422-7212

Other identifiers 1

IdentifierTypeStateIssuer
100242040AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20080625000488 IN Practitioner - Family Practice 5496826059 Reassigns benefits to 2 organizations
Practice locations: Evansville, IN

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

350 W Columbia St
Suite 450
Evansville, IN 47710-5610
Phone (812) 425-1596

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01025468INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical CurrentSince Jan 6, 2023 Accepting new patients
William a. Blume, MD Family Medicine PastSince May 16, 2021 Accepting new patients

Locations

155 E Burks Dr
Bloomington, IN 47401
Phone (812) 332-4437

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1619973179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N 4TH AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477103529",
            "telephone_number": "812-422-7212",
            "fax_number": "812-422-7326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N 4TH AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477103529",
            "telephone_number": "812-422-7212",
            "fax_number": "812-422-7326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RICHARD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01025468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100242040A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.