Active NPI
Theodore T Wagner III, MD
- Urology Physician
- Lafayette, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 01050471A
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100081380 | Medicaid | IN | |
| 0748972 | Medicaid | OH | |
| 000000087512 | Other | IN | ANTHEM BC/BS |
| 200245650 | Medicaid | IN | |
| 2568556 | Medicaid | OH |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
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
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
- Adams Memorial Hospital
- Parkview Huntington Hospital
- Parkview Whitley Hospital
- Parkview Dekalb Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.53 of 100
- Quality
- 70
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.11
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 12 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01050471A | IN | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New 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
- 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.
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1225327984
-
- Family Medicine Physician
- Fort Wayne, IN
- NPI 1932130952
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Decatur, IN
- NPI 1689696148
-
- General Acute Care Hospital
- Auburn, IN
- NPI 1902897937
-
- General Acute Care Hospital
- Huntington, IN
- NPI 1003821729
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1366407603
-
- General Acute Care Hospital
- Columbia City, IN
- NPI 1205844495
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; 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.