Adam Clark Waggoner, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60594917 Issued in WA

Practice address

408 NE 72ND St
Seattle, WA 98115-5409

Phone

(206) 524-5115

Fax

(206) 524-2456

NPI assigned

Jul 26, 2015

Last updated

Nov 30, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prevail Practices PLLCGroup PAC ID 2163781634, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Prevail Practices, PLLC

  dba Prevail Physical Therapy

  • Physical Therapist
  • Shoreline, WA
  • NPI 1740723915
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1437868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1629453139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 NE 72ND ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981155409",
            "telephone_number": "206-524-5115",
            "fax_number": "206-524-2456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 NE 72ND ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981155409",
            "telephone_number": "206-524-5115",
            "fax_number": "206-524-2456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "ADAM",
        "middle_name": "CLARK",
        "name_prefix": "Mr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-26",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60594917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Wadsworth
• Stephen Wadsworth, L.M.P.
• Annabelle Rose Wagar
• Amanda Wager, MSW, MHP
• Susan Wager, MD
• Caroline Mady Waggoner, L.M.P.
• Alpana Waghmare, MD
• Arpan Waghray, MD
• Shyamal Waghwala
• Lauren Wagler

• Physical Therapist in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.