Philip Wagenbach, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

055-0031268 Issued in VT

Practice address

275 Route 30 N
Bomoseen, VT 05732-9647

Phone

(802) 468-5641

Fax

(802) 468-2923

NPI assigned

Aug 13, 2006

Last updated

Oct 5, 2015By the provider in NPPES

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 VT

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Centers of the Rutland Region IncGroup PAC ID 2961467386, 103 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pwagenbach@chcrr.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Health Centers of the Rutland Region, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bomoseen, VT
  • NPI 1336193838
  Medicare reassignment Care Compare group
• Community Health Centers of the Rutland Region Inc

  dba Community Health North Main St

  • Federally Qualified Health Center (FQHC)
  • Rutland, VT
  • NPI 1518613215
  NPD
• Community Health Centers of the Rutland Region, Inc.

  • Family Medicine Physician
  • Brandon, VT
  • NPI 1073567590
  NPD (past)

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

• Rutland Hospital, Inc.

  dba Rutland Regional Medical Center

  • General Acute Care Hospital
  • Rutland, VT
  • NPI 1720042203
  Care Compare affiliation

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444003200000",
    "number": "1790797116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SCHOOL ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605747",
            "telephone_number": "401-616-2000",
            "fax_number": "401-616-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 ROUTE 30 N",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "057329647",
            "telephone_number": "802-468-5641",
            "fax_number": "802-468-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENBACH",
        "first_name": "PHILIP",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2015-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001695",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "055-0031268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janine F. Small, LICSW
• Patricia Szabo, LISW
• Erica E Tamblini, LCSW
• Sarah Stork Tatko, PA
• The Coon House
• Rachel Yrsha

• Medical Physician Assistant in Bomoseen, VT
• Providers in Bomoseen, VT by specialty
• Medical Physician Assistant in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; 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.