Bret Bouton Wagenhorst, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

044138 Issued in GA

Practice address

1803 Old Ocilla Rd
Tifton, GA 31794-1617

Phone

(229) 386-2181

Fax

(229) 386-2193

NPI assigned

Aug 11, 2006

Last updated

Mar 8, 2021By the provider in NPPES

Sex

Male

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 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Ophthalmology

Education

Stanford University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tift Regional Medical Center Hospital, Tifton, GA, CCN 110095

Merit-based Incentive Payment System (MIPS)

Final score

81.02 of 100Reported as group

Quality

57.87

Promoting interoperability

100

Improvement activities

40

Cost

75.97

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bret.wagenhorst@trhs.cernerdirect.com
• Direct secure messaging: bw@tiftregionalophthalmology.direct.eyemdemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tift Regional Health System Inc

  dba Southwell Mobile Clinic

  • Family Medicine Physician
  • Tifton, GA
  • NPI 1881203305
  Medicare reassignment Care Compare group NPD
• Tift Regional Health System Inc

  dba WorkSmart Occupational Medicine

  • Clinic/Center
  • Tifton, GA
  • NPI 1003980996
  NPD
• Tift Regional Health System Inc

  dba Georgia Sports Medicine

  • Orthopaedic Surgery Physician
  • Tifton, GA
  • NPI 1376920488
  NPD
• Tift Regional Health System Inc

  dba Tift Regional Urology

  • Urology Physician
  • Tifton, GA
  • NPI 1386187896
  NPD
• Tift Regional Health System Inc

  dba Tift Regional Ophthalmology

  • Ophthalmology Physician
  • Tifton, GA
  • NPI 1790280857
  NPD

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

• Tift Regional Health System Inc.

  dba Tift Regional Medical Center

  • General Acute Care Hospital
  • Tifton, GA
  • NPI 1962462226
  Care Compare affiliation

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1841201134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E STE 400",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943684",
            "telephone_number": "229-353-3450",
            "fax_number": "229-353-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 OLD OCILLA RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941617",
            "telephone_number": "229-386-2181",
            "fax_number": "229-386-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENHORST",
        "first_name": "BRET",
        "middle_name": "BOUTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "044138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "077471001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "180041335",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00760856A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bret.wagenhorst@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1803 Old Ocilla Rd",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317941617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brisandi Villar, MD
• Bertram Vinson, RN
• Tamieka Shandrell Vinson, PHARMD
• Shankar Narayan Viswanatha
• Vna of Greater Tift Inc.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5198)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1072)
• Wal-Mart Stores East, LP (Vision Center 30-1072)
• Emma Cummins Waldrop, FNP
• Rebecca Golden Waldrop, M.ED, CCC-SLP

• Ophthalmology Physician in Tifton, GA
• Providers in Tifton, GA by specialty
• Ophthalmology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.