Seattle Sports & Regenerative Medicine PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00022633 Issued in WA

Legal business name

SEATTLE SPORTS & REGENERATIVE MEDICINE PLLC

Practice address

1000 Dexter Ave N Ste 320
Seattle, WA 98109-4878

Phone

(206) 999-8556

NPI assigned

May 18, 2017

Last updated

Oct 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark D Wagner, MDNPI 1649211764

Title

Owner

Phone

(206) 999-8556

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark David Wagner, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Seattle, WA
  • NPI 1649211764
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1871020933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 DEXTER AVE N STE 320",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094878",
            "telephone_number": "206-486-7837",
            "fax_number": "206-462-7520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 DEXTER AVE N STE 320",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094878",
            "telephone_number": "206-999-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEATTLE SPORTS & REGENERATIVE MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-18",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-999-8556",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00022633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seattle Spine & Wellness Center
• Seattle Spine and Rehabilitation
• Seattle Spine Institute PLLC
• Seattle Spine Institute PLLC
• Seattle Sport Rehabilitation and Performance
• Seattle Sports Chiropractic & Physical Therapy
• Seattle Surgery Center LLC
• Seattle Therapeutics PS (Thrive Healing Massage)
• Seattle Therapy and Counseling, PLLC
• Seattle Therapy Group, PLLC (Seattle Therapy Group)

• Family Medicine Physician in Seattle, WA
• Providers in Seattle, 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 Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.