Jeannene Rochelle Wagner, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

03552 Issued in NM

Practice address

5320 N Lovington Hwy
Hobbs, NM 88240-9139

Phone

(575) 392-1973

Fax

(575) 392-2030

NPI assigned

Aug 31, 2016

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health Home health agency, Carlsbad, NM, CCN 327172
• Excelacare Home Health Home health agency, Hobbs, NM, CCN 327100
• Covenant Health Hobbs Hospital Hospital, Hobbs, NM, CCN 320065
• Nor-Lea Hospital District Hospital, Lovington, NM, CCN 321305

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwagner2018562@oc.providencedirect.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.

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  NM

  Medicare reassignment Care Compare group NPD
• Covenant Medical Group

  • Rural Health Clinic/Center
  • Abernathy, TX
  • NPI 1538412895
  NPD

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

• Covenant Hospital Hobbs

  • General Acute Care Hospital
  • Hobbs, NM
  • NPI 1215534466
  Care Compare affiliation
• New Mexico Healthcare Services LLC

  • Home Health Agency
  • Hobbs, NM
  • NPI 1851613343
  Care Compare affiliation
• Nor-Lea Hospital District

  • Critical Access Hospital
  • Lovington, NM
  • NPI 1881630036
  Care Compare affiliation
• Wellcare, Inc

  • Home Health Agency
  • Carlsbad, NM
  • NPI 1932537420
  Care Compare affiliation

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1730635566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 N LOVINGTON HWY",
            "city": "HOBBS",
            "state": "NM",
            "postal_code": "882409139",
            "telephone_number": "575-392-1973",
            "fax_number": "575-392-2030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5419 N Lovington Hwy",
            "address_purpose": "LOCATION",
            "city": "Hobbs",
            "state": "NM",
            "postal_code": "882409100",
            "country_code": "US",
            "telephone_number": "575-492-5146",
            "fax_number": "575-492-5666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JEANNENE",
        "middle_name": "ROCHELLE",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "NM",
            "license": "R26431",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "03552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1K3729",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1730635566",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Joy Villanueva, COTA/L
• Isabel Villanueva, LADAC
• Patricia Villanueva
• Viswanatha Reddy Yaratha, MD
• Danielle Vrska
• Brandy Waits
• Lyric Wakeland
• Wal-Mart Stores East LP
• Wal-Mart Stores East. LP
• Walgreen Co

• Family Nurse Practitioner in Hobbs, NM
• Providers in Hobbs, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.