Sarah C Wagner, PA-C
Individual provider Active NPI Physician Assistant · Mill City, OR
NPI 1720174931 · NPPES record last updated May 18, 2021
Key facts
- NPI
- 1720174931
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA161499 (OR)
- Practice address
- 280 S 1St Ave
Mill City, OR 97360-2324 - Phone
- (503) 897-4100
- Fax
- (503) 897-2673
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99 | MT | MD | Professional Counselor |
| 3110 | AZ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Emergency Physicians, PLLC | Past | Accepting new patients | |
| Santiam Memorial Hospital | Past |
Accepting new patients | |
| Santiam Memorial Hospital | Past |
Accepting new patients | |
| Level 4 Medical Professional Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 99 | MT | |
| Physician Assistant | 363A00000X | PA161499 | OR | Yes |
| Physician Assistant | 363A00000X | 3110 | AZ |
Addresses
Primary practice location
280 S 1St Ave
Mill City, OR 97360-2324
Mailing address
PO Box 47
Mill City, OR 97360-0047
Phone (503) 897-4100
Other practice location 1
9290 SE Sunnybrook Blvd
Suite 120
Clackamas, OR 97015-6802
Phone (503) 215-2110
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500657211 | Medicaid | OR | |
| R01271179 | Other | OR | RAILROAD MEDICARE - PH&S |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sarah.wagner.1@14369.direct.athenahealth.com |
Other providers in Mill City, OR
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Natalee Jean Steinkamp
- Amy Sutkus
All providers in Mill City, OR · Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.