Suzanne Wagner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1120402 Issued in KY

Practice address

1200 Breckenridge St
Owensboro, KY 42303-1089

Phone

(270) 683-8672

Fax

(270) 685-8233

NPI assigned

Aug 29, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health Deaconess Medical Group IncGroup PAC ID 6103220330, 241 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Deaconess Madisonville Hospital, Madisonville, KY, CCN 180093

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Baptist Health Deaconess Medical Group Inc

  • Internal Medicine Physician
  • Madisonville, KY
  • NPI 1437730942
  Medicare reassignment Care Compare group
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  KY

  Medicare reassignment
• Baptist Health Deaconess Medical Group Inc

  • Rural Health Clinic/Center
  • Madisonville, KY
  • NPI 1497339667
  NPD
• Baptist Health Deaconess Medical Group Inc

  • Hospitalist Physician
  • Madisonville, KY
  • NPI 1972320430

  Physician Assistant

  NPD
• Baptist Health Deaconess Madisonville Inc

  • Rural Acute Care Hospital
  • Madisonville, KY
  • NPI 1447231956
  NPD (past)
• Owensboro Health Medical Group, Inc

  • Family Medicine Physician
  • Owensboro, KY
  • NPI 1376594242

  Physician Assistant

  NPD (past)

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

• Baptist Health Deaconess Madisonville Inc

  • Rural Acute Care Hospital
  • Madisonville, KY
  • NPI 1447231956
  Care Compare affiliation

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

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1831599505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 BRECKENRIDGE ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031089",
            "telephone_number": "270-684-0028",
            "fax_number": "270-683-8672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BRECKENRIDGE ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031089",
            "telephone_number": "270-683-8672",
            "fax_number": "270-685-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-29",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "1120402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100389910",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.