Preston Thomas Wagner

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05013517A Issued in IN

Practice address

7617 W Jefferson Blvd Ste D
Fort Wayne, IN 46804-4164

Phone

(260) 436-8454

Fax

(260) 489-9121

NPI assigned

Aug 28, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

79.72 of 100Reported as group

Quality

71.87

Promoting interoperability

76

Improvement activities

40

Cost

80.52

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1861040370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9602 COLDWATER RD STE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252095",
            "telephone_number": "260-436-8454",
            "fax_number": "260-489-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7617 W JEFFERSON BLVD STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044164",
            "telephone_number": "260-436-8454",
            "fax_number": "260-489-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PRESTON",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013517A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary E. Wagmeister, ANP
• Alexandria Wagner
• Jamie Lynn Wagner, PTA
• Katherine Wagner
• Megan Nicole Wagner
• Shauna R Wagner, NP
• Cheryl Lea Wagoner, LMHC LICENSED MENTAL
• Tamia Wagstaff
• MHD Anas Wahba, MD,
• Sayed E. Wahezi, MD

• Physical Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.