Ida Janelle Wagner, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA11470600 Issued in NJ

Practice address

3509 N Broad St
Philadelphia, PA 19140-4105

Phone

(215) 707-3933

Fax

(215) 707-2531

NPI assigned

Jul 23, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ida Janelle Dugger Former name

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in NJ

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

Hand Surgery

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022
• Virtua Mount Holly Hospital Hospital, Mount Holly, NJ, CCN 310057
• Virtua Willingboro Hospital Hospital, Willingboro, NJ, CCN 310061

Merit-based Incentive Payment System (MIPS)

Final score

81.15 of 100Reported as group

Quality

62.28

Promoting interoperability

100

Improvement activities

40

Cost

74.89

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: iwagner224467@directvirtua.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.

• Virtua Medical Group, PA

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1649226515

  Surgery

  Medicare reassignment Care Compare group NPD
• Temple Faculty Practice Plan Inc

  dba Temple Faculty Anesthesiology Associates

  • Anesthesiology Physician
  • Philadelphia, PA
  • NPI 1881176949
  NPD
• Virtua Medical Group, PA

  dba Virtua Reconstructive Orthopedics - Delran

  • Orthopaedic Surgery Physician
  • Delran, NJ
  • NPI 1841087988
  NPD
• Virtua Medical Group, PA

  • Urgent Care Clinic/Center
  • Haddon Township, NJ
  • NPI 1932659778
  NPD

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

• Virtua - Memorial Hospital Burlington County, Inc.

  dba Virtua Mount Holly Hospital

  • General Acute Care Hospital
  • Mount Holly, NJ
  • NPI 1134125016
  Care Compare affiliation
• Virtua - West Jersey Health System, Inc.

  • General Acute Care Hospital
  • Voorhees, NJ
  • NPI 1528064409
  Care Compare affiliation
• Virtua Willingboro Hospital Inc

  dba Virtua Health & Wellness Center

  • General Acute Care Hospital
  • Willingboro, NJ
  • NPI 1053316844
  Care Compare affiliation

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1689839177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 Fairview Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Delran",
            "state": "NJ",
            "postal_code": "080751474",
            "country_code": "US",
            "telephone_number": "856-764-8804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "570 Egg Harbor Rd Ste B1",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "080802359",
            "country_code": "US",
            "telephone_number": "856-341-8495",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Bowman Dr Ste E140",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080439631",
            "country_code": "US",
            "telephone_number": "856-983-4263",
            "fax_number": "856-983-9362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "IDA",
        "middle_name": "JANELLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD434346",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA11470600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iwagner224467@directvirtua.org",
            "affiliation": "N",
            "address_1": "1311 Fairview Blvd Ste B",
            "city": "Delran",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080751474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iwagner224467@directvirtua.org",
            "affiliation": "N",
            "address_1": "570 Egg Harbor Rd Ste B1",
            "city": "Sewell",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080802359",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iwagner224467@directvirtua.org",
            "affiliation": "N",
            "address_1": "200 Bowman Dr Ste E140200",
            "city": "Voorhees",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080439623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "IDA",
            "last_name": "DUGGER",
            "middle_name": "JANELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Danielle Carrie Wagner, LCGC
• David K Wagner, MD
• Elizabeth Ann Wagner, DMD
• Gabrielle Wagner
• Hannah Michele Wagner, DMD
• Jason E Wagner, MD
• Jesse Wagner, MD
• Julia Wagner, MSW, LSW
• Kristina Marie Wagner, MD
• Lauren Ashley Wagner, RN

• Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.