Individual provider Active NPI

David Russell Wagner, M.D.

  • Anesthesiology Physician
  • Bronx, NY
National Provider Identifier
1811129547
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
270163 Issued in NY
Practice address
234 E 149TH St
Bronx, NY 10451-5504
Phone
(718) 579-5717
NPI assigned
Aug 13, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 270163 NY Primary

Addresses

Primary practice location

234 E 149TH St
Bronx, NY 10451-5504

Mailing address

253 W 72ND St Apt 1703
New York, NY 10023-2709
Phone (702) 994-2479

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130920000095 NY Practitioner - Anesthesiology 5193969723 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

Hospital & facility affiliations

  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Champlain Valley Physicians Hospital Medical Center Anesthesiology CurrentSince May 1, 2017 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Jul 8, 2013 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center CurrentSince Dec 29, 2018 Accepting new patients
Alice Hyde Medical Center Past Accepting new patients

Locations

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

Interoperability endpoints

  • Direct secure messaging: dwagner182656@direct.uvmhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1811129547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 W 72ND ST APT 1703",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100232709",
            "telephone_number": "702-994-2479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DAVID",
        "middle_name": "RUSSELL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-13",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "270163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.