Active NPI
Hans R Wagenaar, PA-C
- Physician Assistant
- Sioux Falls, SD
National Provider Identifier
1811955073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0447
- Practice address
- 201 W 69TH St
Sioux Falls, SD 57108-2403 - Phone
- (605) 336-0635
- Fax
- (605) 336-7182
- NPI assigned
- May 3, 2006
- Sex
- Male
- 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 | 0447 | SD | Primary |
Addresses
Primary practice location
201 W 69TH St
Sioux Falls, SD 57108-2403
Mailing address
201 W 69TH St
Sioux Falls, SD 57108-2403
Phone (605) 336-0635
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 714427000 | Medicaid | MN | |
| 970015240 | Other | SD | RAILROAD MEDICARE |
| 6821680 | Medicaid | SD |
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
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
201 W 69TH St
Sioux Falls, SD 57108-2403
Phone (605) 336-0635
910 E 20TH St
Sioux Falls, SD 57105-1012
Phone (605) 334-6730
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0447 | SD | MD | Occupational Therapist |
Interoperability endpoints
- hans.wagenaar.p1@direct.urologyspecialists.nextgenshare.com
- hwagenaar@urologyspecialists.gwaydirect.com
Organizations & group practices 1
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.
-
- Urology Physician
- Sioux Falls, SD
- NPI 1881647246
Hospital & facility affiliations 29
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1154531630
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1184834764
-
- Endocrinology, Diabetes & Metabolism Physician
- Sioux Falls, SD
- NPI 1396711016
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328054400000",
"number": "1811955073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W 69TH ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571082403",
"telephone_number": "605-336-0635",
"fax_number": "605-336-7182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 W 69TH ST",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571082403",
"telephone_number": "605-336-0635",
"fax_number": "605-336-7182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENAAR",
"first_name": "HANS",
"middle_name": "R",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2012-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0447",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "714427000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970015240",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6821680",
"state": "SD"
}
],
"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 Feb 1, 2012; 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.