Jessica Wagner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2019009367 Issued in MO

Practice address

1296 Jeffco Blvd
Arnold, MO 63010-2138

Phone

(636) 321-8610

NPI assigned

May 20, 2019

Last updated

Oct 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Aco Clinical Services IncGroup PAC ID 6901188572, 159 clinicians

County of St Louis Division of Fiscal ManagementGroup PAC ID 0941285720, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Joplin Hospital, Joplin, MO, CCN 260001

Medicare enrollment (NPD)

Enrolled

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.

• County of St Louis Division of Fiscal Management

  dba St Louis County Dept of Health

  • State or Local Public Health Clinic/Center
  • Saint Louis, MO
  • NPI 1780639088
  Medicare reassignment Care Compare group
• Mercy Aco Clinical Services Inc

  • Neurology Physician
  • Chesterfield, MO
  • NPI 1063965093
  Medicare reassignment Care Compare group
• SSM Health Care St Louis

  dba SSM Health St Clare Fenton

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• County of St Louis Division of Fiscal Management

  dba John C. Murphy Health Center

  • Federally Qualified Health Center (FQHC)
  • Berkeley, MO
  • NPI 1184519506
  NPD
• SSM Health Care St. Louis

  dba SSM Health St. Mary's Hospital Physician Billing

  • Emergency Medicine Physician
  • Saint Louis, MO
  • NPI 1366400855
  NPD

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

• Mercy Hospital Joplin

  • General Acute Care Hospital
  • Joplin, MO
  • NPI 1700112745
  Care Compare affiliation

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1649837246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 STILLBROOK ESTATES DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630266505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 JEFFCO BLVD",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630102138",
            "telephone_number": "636-321-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-20",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2019009367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1296 Jeffco Blvd",
            "city": "Arnold",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630102138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwagner354428@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jwagner354428@direct-ehr-ssmhc.com",
            "address_1": "1296 Jeffco Blvd",
            "city": "Arnold",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630102138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Walgreen Co (Walgreens #04972)
• Walgreen Co (Walgreens #05058)

• Physician Assistant in Arnold, MO
• Providers in Arnold, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.