Jackson Wagoner, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

19414A Issued in WY

Practice address

1541 Diamond Dr
Casper, WY 82601-6247

Phone

(307) 439-1097

NPI assigned

Apr 9, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, WY2 enrollments

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 2

Specialty

Anesthesiology

Education

Nebraska College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Summit Memorial Medical Group LLCGroup PAC ID 1254876683, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Summit Medical Center Hospital, Casper, WY, CCN 530034
• Memorial Hospital of Converse County Hospital, Douglas, WY, CCN 531302
• Campbell County Health Hospital, Gillette, WY, CCN 530002
• Sagewest Health Care Hospital, Riverton, WY, CCN 530008
• Platte County Hospital Hospital, Wheatland, WY, CCN 531305

Merit-based Incentive Payment System (MIPS)

Final score

47.54 of 100Reported as apm

Quality

38.49

Promoting interoperability

0

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

93.34 of 100Reported as apm

Quality

74.56

Promoting interoperability

99

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

85.62 of 100Reported as group

Quality

77.5

Promoting interoperability

100

Improvement activities

40

Cost

74.58

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: jackson.wagoner@direct.aultman.org

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.

• Summit Memorial Medical Group LLC

  • General Practice Physician
  • Casper, WY
  • NPI 1598469462
  Medicare reassignment Care Compare group NPD
• Florida Clinical Practice Association Inc

  • Surgery Physician
  • Gainesville, FL
  • NPI 1063463768
  Medicare reassignment NPD
• Gem City Bone & Joint PC

  • Ambulatory Surgical Clinic/Center
  • Laramie, WY
  • NPI 1518947589
  Medicare reassignment
• Florida Clinical Practice Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Ocala, FL
  • NPI 1609529478
  NPD

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

• Campbell County Hospital District

  • General Acute Care Hospital
  • Gillette, WY
  • NPI 1487638417
  Care Compare affiliation
• Campbell County Hospital District

  • Ambulatory Surgical Clinic/Center
  • Gillette, WY
  • NPI 1780738153

  Hospital

  Care Compare affiliation
• Memorial Hospital of Converse County

  • Critical Access Hospital
  • Douglas, WY
  • NPI 1326085408
  Care Compare affiliation
• Platte County Hospital

  • Critical Access Hospital
  • Guernsey, WY
  • NPI 1265469506
  Care Compare affiliation
• Platte County Memorial Nursing Home

  • Skilled Nursing Facility
  • Wheatland, WY
  • NPI 1003951518

  Hospital

  Care Compare affiliation
• Riverton Memorial Hospital LLC

  • Rural Acute Care Hospital
  • Lander, WY
  • NPI 1245337286
  Care Compare affiliation
• Summit Medical Center, LLC

  • General Acute Care Hospital
  • Casper, WY
  • NPI 1609297506
  Care Compare affiliation

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1689137408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100254",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100254",
            "telephone_number": "352-273-8610",
            "fax_number": "352-273-8612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 DIAMOND DR",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826016247",
            "telephone_number": "307-439-1097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Sixth St SW",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447101702",
            "country_code": "US",
            "telephone_number": "330-452-9911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326101702",
            "country_code": "US",
            "telephone_number": "352-273-8610",
            "fax_number": "352-273-8612",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 N Campbell Ave Rm 4401",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857240001",
            "country_code": "US",
            "telephone_number": "520-626-7721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-09",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME169309",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "69349",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WY",
            "license": "19414A",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME169309",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackson.wagoner@direct.aultman.org",
            "affiliation": "N",
            "endpointDescription": "Direct address via employer",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2600 Sixth St SW",
            "city": "Canton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "447101702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vop Garden Square of Casper, LLC
• Sara Elizabeth Vrbas
• Mark D. Vuolo, M.D.
• Breeana Nicole Wade, DO
• William Gregory Wagner, M.A.
• Jennifer Ella Wagy, DNP, FNP-BC, NP-C
• Felicia Marie Walden, NP
• Melinda Marie Walden, MSN, APRN, FNP-C
• Amanda Waldron
• Lea Wales

• Pain Medicine (Anesthesiology) Physician in Casper, WY
• Providers in Casper, WY by specialty
• Pain Medicine (Anesthesiology) Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.

Verify at the official NPI Registry.