Robert Allan Wageneck, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OP60971885 Issued in WA

Practice address

521 E Mountain View Ave
Ellensburg, WA 98926-3865

Phone

(509) 962-1414

Fax

(509) 962-1408

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

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

Family Practice

Education

University of North Texas HSC, College of Osteopathic Med, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kittitas County Public Hospital Dist 1Group PAC ID 0547179608, shared by 7 NPIs, 82 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kittitas Valley Community Hospital Hospital, Ellensburg, WA, CCN 501333

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rwageneck606291@direct.ochin.org

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.

• Community Health of Central Washington

  • Federally Qualified Health Center (FQHC)
  • Yakima, WA
  • NPI 1598764920

  Family Medicine

  Medicare reassignment NPD
• Community Health of Central Washington

  dba Highland Clinic

  • Federally Qualified Health Center (FQHC)
  • Tieton, WA
  • NPI 1700255874
  NPD
• Kittitas County Public Hospital Dist 1

  dba Kittitas Valley Community Hospital

  • Critical Access Hospital
  • Ellensburg, WA
  • NPI 1356375307
  NPD (past)
• Kittitas County Public Hospital Dist 1

  dba KVH Internal Medicine

  • Rural Health Clinic/Center
  • Ellensburg, WA
  • NPI 1932115391
  NPD (past)

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

• Kittitas County Public Hospital Dist 1

  dba Kittitas Valley Community Hospital

  • Critical Access Hospital
  • Ellensburg, WA
  • NPI 1356375307
  Care Compare affiliation

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1861450314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-853-1082",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E MOUNTAIN VIEW AVE",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263865",
            "telephone_number": "509-962-1414",
            "fax_number": "509-962-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENECK",
        "first_name": "ROBERT",
        "middle_name": "ALLAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N2875",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60971885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2142124",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "414072",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard D Vaughan, M.D.
• Jessica Alexis Vaughn
• Julie Verheul, LMHC
• Carmen-Ecaterina Visan, LMHC
• Alexa Leigh Voss
• Myranda Mary Wagner
• Alyssa Walker
• Camille E Walker, D.D.S.
• Jamie L Walker, ARNP, MN
• Jasmine Marcel Walker

• Family Medicine Physician in Ellensburg, WA
• Providers in Ellensburg, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.