Joelle Susan Wagner, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

025951-01 Issued in NY

Practice address

767 Main Street
West Seneca, NY 14224

Phone

(716) 361-1624

NPI assigned

Oct 25, 2018

Last updated

Dec 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wny Rehabilitation Medicine and Pain Management LLCGroup PAC ID 2769667476, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.78 of 100Reported as group

Quality

87.1

Promoting interoperability

95

Improvement activities

40

Cost

86.98

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wny Rehabilitation Medicine and Pain MGMT LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • West Seneca, NY
  • NPI 1164722054
  Medicare reassignment Care Compare group
• University at Buffalo Neurosurgery, Inc.

  • Neurological Surgery Physician
  • Williamsville, NY
  • NPI 1306896220
  Medicare reassignment NPD

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

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1750858981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 MAIN STREET",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "14224",
            "telephone_number": "716-361-1624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 MAIN STREET",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "14224",
            "telephone_number": "716-361-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOELLE",
        "middle_name": "SUSAN",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-25",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "025951-01",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Vona, RN
• Karyn E Voos, M.A., NCSP
• Vyjanthanath Rohan Gunasingham, M.D.
• Kathryn Rand Wacker, DDS
• Shellean A Wade
• Karen Ann Wailand, PHARM.D
• Walgreen Co
• Kelsey Walrath
• Michelle Elizabeth Waney, LCSW
• Catherine Wang

• Surgical Physician Assistant in West Seneca, NY
• Providers in West Seneca, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.