John Edward Wagner, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL06420400 Issued in NJ

Practice address

53 Orchard St
Clifton, NJ 07013-1832

Phone

(973) 773-7600

Fax

(973) 773-7011

NPI assigned

Oct 18, 2019

Last updated

Oct 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychiatry on Video LLCGroup PAC ID 6800269432, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: john.wagner@cinq-nyipa.medentdirect.com

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.

• Psychiatry on Video LLC

  • Psychiatry Physician
  • Ridgewood, NJ
  • NPI 1700532587
  Medicare reassignment Care Compare group NPD
• Premier Psychiatric Consultants LLC

  • Adult Mental Health Clinic/Center
  • West New York, NJ
  • NPI 1508182072
  Medicare reassignment NPD
• Adult Family Health Services LLC

  • Mental Health Counselor
  • Clifton, NJ
  • NPI 1043786254
  NPD (past)
• Adult Family Health Services LLC

  • Community/Behavioral Health Agency
  • Clifton, NJ
  • NPI 1669956298
  NPD (past)

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1649813973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 ORCHARD ST",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070131832",
            "telephone_number": "973-773-7600",
            "fax_number": "973-773-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 ORCHARD ST",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070131832",
            "telephone_number": "973-773-7600",
            "fax_number": "973-773-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-18",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06420400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Lyn Volpe, PT, DPT, COMT
• Volunteers of America- Greater New York
• Bianca Ida Voss, RN
• Monika Maria Waclaw, DMD
• Christian Wagner
• Lorraine Walder, PT
• Walgreen Co (Rite Aid #1746)
• Walgreen Co (Walgreens #11357)
• Walgreen Co (Rite Aid #20809)
• Walgreen Co (Walgreens #06382)

• Social Worker in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.