Matthew Wagner, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-11361 Issued in AR

Practice address

1701 Club Manor Dr Ste 2B
Maumelle, AR 72113

Phone

(501) 812-7216

NPI assigned

Jun 17, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 21, 2025 through May 21, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536019200000",
    "number": "1790166445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 2B",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-812-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 2B",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "72113",
            "telephone_number": "501-812-7216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 N Kansas St",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672143124",
            "country_code": "US",
            "telephone_number": "316-293-2665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-17",
        "last_updated": "2018-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-11361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pearl Amber Turney, OTRL
• United Methodist Behavioral Health System, Inc
• University of Arkansas for Medical Sciences
• Jessica Upchurch, NP
• Stephanie Vangilder, PHARMD
• Walgreen Co
• Andrea Walker
• Lucus Austin Walker, QBHP
• Dionne H Wallace, CNP
• Kaelee Wallace, PT, DPT

• Family Medicine Physician in Maumelle, AR
• Providers in Maumelle, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.