Frederick Wagner, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036124604 Issued in IL

Practice address

5921 Meridian Woods Drive
Glen Carbon, IL 62034-1545

Phone

(618) 391-5883

NPI assigned

Jun 22, 2005

Sex

Male

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 MO, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Anesthesiology

Education

Saint Louis University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Millennium Anesthesiology Consultants LLCGroup PAC ID 2961974944, 5 clinicians

G and G Anesthesia LLCGroup PAC ID 4981912607, 92 clinicians

Millennium Anesthesiology Consultants, LLCGroup PAC ID 9133250475, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Anderson Hospital Hospital, Maryville, IL, CCN 140289

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Millennium Anesthesiology Consultants, LLC

  • Anesthesiology Physician
  • Maryville, IL
  • NPI 1710218094
  Medicare reassignment Care Compare group NPD Authorized official
• Millennium Anesthesiology Consultants LLC

  • Anesthesiology Physician
  • Chesterfield, MO
  • NPI 1730033713
  Medicare reassignment Care Compare group NPD Authorized official
• G & G Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Maryville, IL
  • NPI 1487020111
  Medicare reassignment Care Compare group
• Tenet Healthsystem Di, Inc.

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1104857994
  NPD (past)

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

• Anderson Hospital

  • General Acute Care Hospital
  • Maryville, IL
  • NPI 1053481630
  Care Compare affiliation

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492128000000",
    "number": "1770589053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BLUFF AVE",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298413862",
            "telephone_number": "800-394-4445",
            "fax_number": "706-396-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5921 MERIDIAN WOODS DRIVE",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341545",
            "telephone_number": "618-391-5883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2017-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "113352",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036124604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770589053",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205374309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maggie Marie Von Seng
• Christina Voss
• Vuagniaux Upper Cervical, LLC
• Nikki Vuagniaux, DC
• Thad S Vuagniaux
• Wal-Mart Stores, Inc
• Walgreen Co
• Walgreen Co.
• Shannon Nicole Walker, PH.D.
• Stephanie Wallace, SLP

• Anesthesiology Physician in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; 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.