Individual provider Active NPI

Theodore T Wagner III, MD

  • Urology Physician
  • Lafayette, IN
National Provider Identifier
1831162791
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
01050471A Issued in IN
Practice address
3920 St Francis Way Ste 105
Lafayette, IN 47905-4917
Phone
(765) 502-4000
Fax
(765) 502-4709
NPI assigned
Feb 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 01050471A IN Primary

Addresses

Primary practice location

3920 St Francis Way Ste 105
Lafayette, IN 47905-4917

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

11141 Parkview Plaza Dr Ste 325
Fort Wayne, IN 46845-1714
Phone (260) 425-5400

Other identifiers 5

IdentifierTypeStateIssuer
100081380MedicaidIN
0748972MedicaidOH
000000087512OtherINANTHEM BC/BS
200245650MedicaidIN
2568556MedicaidOH

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address twagner8867@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20031217000099 IN Practitioner - Urology 5092611632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Ohio State University College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

3920 St Francis Way
Suite 105
Lafayette, IN 47905-4917
Phone (765) 428-1660

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Adams Memorial Hospital Hospital, Decatur, IN, CCN 151330
  • Parkview Huntington Hospital Hospital, Huntington, IN, CCN 150091
  • Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101
  • Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01050471AINMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System Inc Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

7900 W Jefferson Blvd
Ste 301
Fort Wayne, IN 46804
Phone (219) 436-6667

2512 E DuPont Rd
Ste 100
Fort Wayne, IN 46825
Phone (260) 347-4459

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

1818 Carew St
Ste 210
Fort Wayne, IN 46805
Phone (260) 425-5400

2512 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 222-7401

3702 New Vision Dr
Bldg B
Fort Wayne, IN 46845
Phone (260) 266-8210

11141 Parkview Plaza Dr
Ste 325
Fort Wayne, IN 46845
Phone (260) 425-5400

11050 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 266-7100

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

140 Fox Rd
Ste 404
Van Wert, OH 45891
Phone (419) 238-2476

Interoperability endpoints

  • Direct secure messaging: twagner8867@direct.parkviewexchange.com

Organizations & group practices 3

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 6

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1831162791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 ST FRANCIS WAY STE 105",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054917",
            "telephone_number": "765-502-4000",
            "fax_number": "765-502-4709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11141 Parkview Plaza Dr Ste 325",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451714",
            "country_code": "US",
            "telephone_number": "260-425-5400",
            "fax_number": "260-425-5417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "THEODORE",
        "middle_name": "T",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01050471A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100081380",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0748972",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000087512",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200245650",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2568556",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twagner8867@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 325",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 325",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 325",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.