Joshua James Wageman, PA-C, DPT, CSCS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1896 Issued in ID

Practice address

951 E Plaza Dr Ste 110
Eagle, ID 83616-6567

Phone

(208) 274-9580

NPI assigned

Jul 24, 2013

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

Medicare fee-for-service enrollment

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Idaho Diabetes and Endocrine Associates, PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Boise, ID
  • NPI 1790960961
  Medicare reassignment
• Treasure Valley Metabolic Medicine

  • Endocrinology, Diabetes & Metabolism Physician
  • Eagle, ID
  • NPI 1285271635
  Medicare reassignment

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1770925257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5049 E GERANIUM ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837167044",
            "telephone_number": "208-870-1882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR STE 110",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166567",
            "telephone_number": "208-274-9580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13909 W Wainwright Dr",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837131969",
            "country_code": "US",
            "telephone_number": "208-389-2213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGEMAN",
        "first_name": "JOSHUA",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "PA-C, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-24",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-3184",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathleen Vicini, MFT, PSY.D.
• Paul Charles Villaret, PHARMD
• Abram Paul Vore, AUD
• Christopher Waag, PHARMD
• Grant Wade, PT, DPT
• Kassidy Diane Wagner, BCBA
• Laila Wahdan, DACCHM, MTCM, L.AC.
• Deborah Anne Waite, MACCC-SLP
• Alex Wald
• Walgreen Co

• Physician Assistant in Eagle, ID
• Providers in Eagle, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.