NPIMap

Individual provider Active NPI

Timothy J Wagner, MD

  • Family Medicine Physician
  • Shiner, TX
National Provider Identifier
1851372619
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J0340 Issued in TX
Practice address
124 E Wolters 2ND
Shiner, TX 77984-7109
Phone
(361) 594-3824
Fax
(361) 594-4104
NPI assigned
Nov 9, 2005
Last updated
Jul 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J0340 TX Primary

Addresses

Primary practice location

124 E Wolters 2ND
Shiner, TX 77984-7109

Mailing address

PO Box 965
Shiner, TX 77984-0965
Phone (361) 594-3824

Other identifiers 3

IdentifierTypeStateIssuer
836T776OtherTXBLUE CROSS
135624802MedicaidTX
82Y592OtherTXBC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100614000054 TX Practitioner - Family Practice 8628065075 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shiner Medical LLPGroup PAC ID 0244579761, 3 clinicians
DRS Wagner Andwagner PAGroup PAC ID 6507853280, 3 clinicians

Practice addresses (Care Compare)

124 E Wolters 2ND St
Shiner, TX 77984-7109
Phone (361) 594-3824

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.3 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions23
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DRS Wagner & Wagner PA Family Medicine CurrentSince Jan 14, 1992 Accepting new patients
Shiner Medical LLP Family Medicine CurrentSince Oct 20, 2018 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Yoakum Community Hospital Past Accepting new patients
Wagner Medical Clinic L.L.P. Past Accepting new patients

Locations

124 E Wolters 2nd St
Shiner, TX 77984
Phone (361) 594-3824

Interoperability endpoints

  • Direct secure messaging: tim.wagner@wagnerclinic.directbygreenway.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Moulton ClinicMoulton, TX, CCN 458968 Rural health clinic General Partnership Interest Oct 8, 2004
Wagner Medical Clinic L.L.P.Shiner, TX, CCN 458912 Rural health clinic General Partnership Interest Jul 14, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1851372619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 965",
            "city": "SHINER",
            "state": "TX",
            "postal_code": "779840965",
            "telephone_number": "361-594-3824",
            "fax_number": "361-594-4104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E WOLTERS 2ND",
            "city": "SHINER",
            "state": "TX",
            "postal_code": "779847109",
            "telephone_number": "361-594-3824",
            "fax_number": "361-594-4104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J0340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "836T776",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135624802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "82Y592",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shiner, TX

Sources for this page

Verify at the official NPI Registry.