NPIMap

Individual provider Active NPI

Lawrence David Wagman, MD

  • Surgical Oncology Physician
  • Upland, CA
National Provider Identifier
1720180383
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
G55578 Issued in CA
Practice address
1100 San Bernardino Road
Suite 1100
Upland, CA 91786-4952
Phone
(909) 949-2242
Fax
(909) 981-5783
NPI assigned
Sep 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X G55578 CA
Surgical Oncology Physician 2086X0206X G55578 CA Primary

Addresses

Primary practice location

1100 San Bernardino Road
Suite 1100
Upland, CA 91786-4952

Mailing address

PO Box 512185
Los Angeles, CA 90051-0185

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@cityofhope.direct-ci.com Direct CITY OF HOPE MEDICAL FOUNDATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100322000788 CA Practitioner - General SurgeryPractitioner - Surgical Oncology 9830224344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Surgical Oncology
Education
Columbia University College of Physicians and Surgeons, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of Hope Medical FoundationGroup PAC ID 3779751656, 964 clinicians

Practice addresses (Care Compare)

1100 San Bernardino Rd
Suite 1100
Upland, CA 91786-4923
Phone (909) 949-2242

Hospital & facility affiliations

  • City of Hope Helford Clinical Research Hospital Hospital, Duarte, CA, CCN 050146
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Merit-based Incentive Payment System (MIPS)

Final score
92.8 of 100Reported as group
Quality
78.51
Promoting interoperability
100
Improvement activities
40
Cost
70.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy29
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G55578CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Foundation Surgery CurrentSince Oct 19, 2019 Accepting new patients
City of Hope Medical Group, Inc. Surgery Current Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
California Cancer Specialists Medical Group Inc Surgery Past Accepting new patients
Casa Colina Hospital and Centers for Healthcare Past Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

1500 Duarte Rd
Duarte, CA 91010
Phone (626) 359-8111

7777 Milliken Ave
Ste 110
Rch Cucamonga, CA 91730
Phone (909) 948-7590

6939 Palm Ct
Riverside, CA 92506
Phone (760) 416-4832

209 Fair Oaks Ave
South Pasadena, CA 91030
Phone (626) 359-8111

1100 San Bernardino Rd
Ste 1100
Upland, CA 91786
Phone (909) 949-2242

23861 McBean Pkwy
Ste B14
Valencia, CA 91355
Phone (661) 799-1999

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: direct@cityofhope.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1720180383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 512185",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900510185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SAN BERNARDINO ROAD",
            "address_2": "SUITE 1100",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864952",
            "telephone_number": "909-949-2242",
            "fax_number": "909-981-5783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGMAN",
        "first_name": "LAWRENCE",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-03",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G55578",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "CA",
            "license": "G55578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@cityofhope.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "CITY OF HOPE MEDICAL FOUNDATION",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Duarte Rd",
            "city": "Duarte",
            "state": "CA",
            "country_code": "US",
            "postal_code": "910103012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.