Active NPI
Molly Brown Wagoner, PA-C
- Physician Assistant
- Sioux Falls, SD
National Provider Identifier
1780820324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2501 W 22ND St
Sioux Falls, SD 57105-1305 - Phone
- (605) 336-3230
- NPI assigned
- Jan 4, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
2501 W 22ND St
Sioux Falls, SD 57105-1305
Mailing address
2501 W 22ND St
Sioux Falls, SD 57105-1305
Phone (605) 336-3230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130327000547 | SD | Order and Referring Only - Physician Assistant | 4981849791 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704 | SD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231027200000",
"number": "1780820324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 W 22ND ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571051305",
"telephone_number": "605-336-3230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 W 22ND ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571051305",
"telephone_number": "605-336-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "MOLLY",
"middle_name": "BROWN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-04",
"last_updated": "2009-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2009; 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.