NPIMap

Individual provider Active NPI

Angela B Wagner, D.O.

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Indianapolis, IN
National Provider Identifier
1710928270
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
02002402A Issued in IN
Practice address
5926 Crawfordsville Rd Unit B
Indianapolis, IN 46224-3722
Phone
(317) 653-2730
Fax
(317) 321-1935
NPI assigned
Jun 8, 2006
Last updated
Aug 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 02002402A IN
Family Medicine Physician 207Q00000X 02002402A IN
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 02002402A IN Primary

Addresses

Primary practice location

5926 Crawfordsville Rd Unit B
Indianapolis, IN 46224-3722

Mailing address

30 W Monroe St Ste 1200
Chicago, IL 60603-2420
Phone (815) 861-4302

Other practice location 1

8450 N Payne Rd
Suite 100
Indianapolis, IN 46268-6620
Phone (317) 338-9686

Other identifiers 2

IdentifierTypeStateIssuer
200411540CMedicaidIN
200411540MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group, PC PastSince Aug 30, 2020 Accepting new patients
Major Hospital Past Accepting new patients
Indianapolis Osteopathic Hospital Inc. Neuromusculoskeletal Medicine & Omm Past Accepting new patients
Hancock Physician Network, LLC Family Medicine Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1710928270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W MONROE ST STE 1200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606032420",
            "telephone_number": "815-861-4302",
            "fax_number": "773-866-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5926 CRAWFORDSVILLE RD UNIT B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462243722",
            "telephone_number": "317-653-2730",
            "fax_number": "317-321-1935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8450 N Payne Rd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462686620",
            "country_code": "US",
            "telephone_number": "317-338-9686",
            "fax_number": "317-338-4044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANGELA",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IN",
            "license": "02002402A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02002402A",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "IN",
            "license": "02002402A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200411540C",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200411540",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.