Heidi Wagner, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3901 Issued in OH

Practice address

3200 S University Dr
Nsu the Eye Institute Suite 1402
Davie, FL 33328-2018

Phone

(954) 262-1402

Fax

(954) 262-1818

NPI assigned

Nov 21, 2006

Last updated

Jan 28, 2016By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marshall B Ketchum UniversityGroup PAC ID 9739075177, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Marshall B. Ketchum University

  • Optometrist
  • Anaheim, CA
  • NPI 1720101876
  Medicare reassignment Care Compare group NPD
• Marshall B. Ketchum University

  dba Ketchum Health Medical Clinic

  • Multi-Specialty Clinic/Center
  • Anaheim, CA
  • NPI 1174037493
  NPD

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453939200000",
    "number": "1689749483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 W 10TH AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101280",
            "telephone_number": "954-384-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "NSU THE EYE INSTITUTE SUITE 1402",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-1402",
            "fax_number": "954-262-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "HEIDI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2016-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620499600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walmene Volcy
• Kristina Von Born
• Aditya Vora, D.O.
• Francesco Paul Vultaggio, D.M.D.
• VV Chiropractic Inc.
• Phyllis A. Wagner, ARNP
• Taylor Elizabeth Wagner
• Sarah Elizabeth Wakefield, AU.D.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2987)
• Wal-Mart Stores East LP (Wal-Mart Vision Center 30-2987)

• Optometrist in Davie, FL
• Providers in Davie, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2016; 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.