Kevin Wagner, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5012830 Issued in NC

Practice address

1001 Blythe Blvd
Ste 300- Adult Cardiology
Charlotte, NC 28203-5866

Phone

(704) 373-0212

NPI assigned

Feb 11, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, MO2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Joplin LLCGroup PAC ID 0547300196, 288 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Joplin Hospital, Joplin, MO, CCN 260001
• Mercy Hospital Carthage Hospital, Carthage, MO, CCN 261338
• Mercy Hospital Pittsburg, Inc Hospital, Pittsburg, KS, CCN 170006

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ambulatory@direct.carolinashealthcare.org

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.

• Mercy Clinic Joplin LLC

  • Family Medicine Physician
  • Joplin, MO
  • NPI 1215264817
  Medicare reassignment Care Compare group NPD
• Carolinas Medical Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment NPD
• The Charlotte-Mecklenburg Hospital Authority

  • Medical Oncology Physician
  • Indian Land, SC
  • NPI 1669738829

  NC

  Medicare reassignment NPD
• Carolinas Medical Center

  • Surgical Critical Care Physician
  • Charlotte, NC
  • NPI 1699979732
  NPD
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Carolinas Physicians Network Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Carolinas Physicians Network Inc

  • Cardiovascular Disease Physician
  • Concord, NC
  • NPI 1710290564
  NPD
• The Charlotte-Mecklenburg Hospital Authority

  • Social Worker
  • Concord, NC
  • NPI 1588178370
  NPD
• The Charlotte-Mecklenburg Hospital Authority

  • Rehabilitation Hospital Unit
  • Charlotte, NC
  • NPI 1962987131
  NPD
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  NPD

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

• Mercy Hospital Carthage

  • Critical Access Hospital
  • Carthage, MO
  • NPI 1003201955
  Care Compare affiliation
• Mercy Hospital Carthage

  • General Acute Care Hospital
  • Carthage, MO
  • NPI 1396012753
  Care Compare affiliation
• Mercy Hospital Joplin

  • General Acute Care Hospital
  • Joplin, MO
  • NPI 1700112745
  Care Compare affiliation
• Mercy Hospital Pittsburg Inc

  • General Acute Care Hospital
  • Pittsburg, KS
  • NPI 1639921430
  Care Compare affiliation

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

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1821620451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BLYTHE BLVD",
            "address_2": "STE 300- ADULT CARDIOLOGY",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035866",
            "telephone_number": "704-373-0212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "STE 300 - Thoracic Surgery",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-667-3840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "Ste 300 - Cardiac Surgery",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Mercy Way",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648044524",
            "country_code": "US",
            "telephone_number": "865-539-8040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KEVIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-11",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2021021010",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "204420",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1001 Blythe Blvd",
            "address_2": "STE 300- Adult Cardiology",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Wagner, LMFT
• Emily Katherine Wagner, PA-C
• Erin Leslie Wagner, DO
• Heather Wagner, MS CCC-SLP
• Judith Rea Wagner, CRNA
• Kristin Elizabeth Wagner, M.D.
• Stephanie Wagner, LCSW, LISW-CP
• Theresa Renee Wagner, BCABA
• David Wagoner, M.D.
• Fallon Wagoner

• Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.