Active NPI
Jeanne Wagoner
- Specialist
- Cleveland HTS, OH
National Provider Identifier
1760880314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 34778885
- Practice address
- 2400 Roxboro Rd
Cleveland HTS, OH 44106-3624 - Phone
- (216) 320-3136
- NPI assigned
- Dec 15, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 34778885 | OH | Primary |
Addresses
Primary practice location
2400 Roxboro Rd
Cleveland HTS, OH 44106-3624
Mailing address
17556 Fairlawn Dr
Chagrin Falls, OH 44023-6419
Phone (216) 320-3136
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34778885 | OH | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418601600000",
"number": "1760880314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17556 FAIRLAWN DR",
"city": "CHAGRIN FALLS",
"state": "OH",
"postal_code": "440236419",
"telephone_number": "216-320-3136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 ROXBORO RD",
"city": "CLEVELAND HTS",
"state": "OH",
"postal_code": "441063624",
"telephone_number": "216-320-3136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "JEANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-15",
"last_updated": "2014-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OH",
"license": "34778885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.