Mark David Wagner, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

MD00022633 Issued in WA

Practice address

1000 Dexter Ave N Ste 320
Seattle, WA 98109-4878

Phone

(206) 620-0333

Fax

(206) 462-7520

NPI assigned

Jun 9, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Family PracticeAlso: Sports Medicine

Education

University of South Florida College of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Swedish Medical Center / Cherry Hill Hospital, Seattle, WA, CCN 500025
• Olympic Medical Center Hospital, Port Angeles, WA, CCN 500072

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Seattle Sports & Regenerative Medicine PLLC

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1871020933
  Medicare reassignment NPD Authorized official
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment NPD
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463
  NPD
• Proliance Surgeons Inc., P.S.

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Seattle, WA
  • NPI 1740229699
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Clallam County Public Hospital District 2

  • General Acute Care Hospital
  • Port Angeles, WA
  • NPI 1306845557
  Care Compare affiliation
• Swedish Health Services

  • General Acute Care Hospital
  • Seattle, WA
  • NPI 1356496582
  Care Compare affiliation

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1649211764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 DEXTER AVE N STE 320",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094878",
            "telephone_number": "206-620-0333",
            "fax_number": "206-462-7520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 DEXTER AVE N STE 320",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094878",
            "telephone_number": "206-620-0333",
            "fax_number": "206-462-7520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Dexter Ave N Ste 320",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981094878",
            "country_code": "US",
            "telephone_number": "206-620-0333",
            "fax_number": "206-462-7520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "MD00022633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "378219",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer C Wagner, CCC-SLP
• John William Wagner, D.D.S.
• Joy Veronica Wagner, OTR, LMP
• Lara Reid Wagner, M.D.
• Laura Beth Wagner, MA, LMHC
• Oliver Jens Wagner, M.D.
• Silvia Aline Wagner
• Suzanne P Wagner
• Teresa Wagner, MD
• Theodore A Wagner, MD

• Sports Medicine (Family Medicine) Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Sports Medicine (Family Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.

Verify at the official NPI Registry.