Active NPI
Richard Alan Wagner, M.D.
- Family Medicine Physician
- Evansville, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01025468
- 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, 2026
- 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 | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100242040A | Medicaid | IN |
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
Enrollment records 1
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
| License | State | Type | Specialty |
|---|---|---|---|
| 01025468 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theoria Medical | Current | Accepting new patients | |
| William a. Blume, MD | Family Medicine | Past | 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.
-
- Family Medicine Physician
- Evansville, IN
- NPI 1952392490
-
- Family Medicine Physician
- Evansville, IN
- NPI 1225610546
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba The Women's Hospital
- General Acute Care Hospital
- Newburgh, IN
- NPI 1780535427
-
- General Acute Care Hospital
- Evansville, IN
- NPI 1053361642
-
dba Deaconess Henderson Hospital
- General Acute Care Hospital
- Henderson, KY
- NPI 1083759633
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; 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.