Active NPI
Diana Theresa Wagner, M.D.
- Pediatrics Physician
- Hilliard, OH
National Provider Identifier
1821084278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35063681W
- Practice address
- 4595 Trueman Boulevard
Hilliard, OH 43026-2576 - Phone
- (614) 529-0771
- Fax
- (614) 529-2370
- NPI assigned
- Sep 21, 2005
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35063681W | OH | Primary |
Addresses
Primary practice location
4595 Trueman Boulevard
Hilliard, OH 43026-2576
Mailing address
1021 Country Club Rd
Suite a
Columbus, OH 43213-2470
Phone (614) 501-7337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0102105 | Medicaid | OH |
Other names 1
- Diana Theresa Morrissey
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35063681W | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Assoicates, Inc. | Pediatrics | Past | Accepting new patients |
| Oh Independent Medical Group LLC | Past | Accepting new patients |
Interoperability endpoints
- diana.wagner.2@26020.direct.athenahealth.com
- diana.wagner@pai.gwaydirect.com
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Columbus, OH
- NPI 1497482111
-
- Pediatrics Physician
- Canal Winchester, OH
- NPI 1457346090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1821084278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 COUNTRY CLUB RD",
"address_2": "SUITE A",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432132470",
"telephone_number": "614-501-7337",
"fax_number": "614-434-2701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4595 TRUEMAN BOULEVARD",
"city": "HILLIARD",
"state": "OH",
"postal_code": "430262576",
"telephone_number": "614-529-0771",
"fax_number": "614-529-2370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DIANA",
"middle_name": "THERESA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-21",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35063681W",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0102105",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DIANA",
"last_name": "MORRISSEY",
"middle_name": "THERESA",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hilliard, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.