Justin Philip Wagner, M.D.

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

A117746 Issued in CA

Practice address

200 UCLA Medical PLZ # 265
Los Angeles, CA 90095-8344

Phone

(310) 206-2429

NPI assigned

Apr 7, 2010

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwagner53533@direct.uclahealth.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.

• County of Los Angeles

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• The Regents of the University of California

  • Pediatric Surgery Physician
  • Los Angeles, CA
  • NPI 1851357941
  Medicare reassignment NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD
• County of Los Angeles Auditor Controller

  • General Acute Care Hospital
  • Sylmar, CA
  • NPI 1134159320
  NPD
• Dignity Community Care

  • General Acute Care Hospital
  • Northridge, CA
  • NPI 1417089350
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Bakersfield, CA
  • NPI 1104981661
  NPD (past)
• Los Robles Regional Medical Center

  • General Acute Care Hospital
  • Thousand Oaks, CA
  • NPI 1033163019
  NPD (past)
• Providence Health System - Southern California

  • Psychiatric Hospital Unit
  • San Pedro, CA
  • NPI 1154349371
  NPD (past)
• Providence Health System - Southern California

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  NPD (past)
• Regents Univ of Calif Los Angeles

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)
• The Regents of the University of California

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1982849105
  NPD (past)
• Torrance Memorial Medical Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1740268713
  NPD (past)

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1871818484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ # 265",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958344",
            "telephone_number": "310-206-2429"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27235 Tourney Rd Ste 2500",
            "address_purpose": "LOCATION",
            "city": "Santa Clarita",
            "state": "CA",
            "postal_code": "913555908",
            "country_code": "US",
            "telephone_number": "310-206-2429",
            "fax_number": "310-206-1120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JUSTIN",
        "middle_name": "PHILIP",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A117746",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CA",
            "license": "A117746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cory Wagner, MD
• Cynthia Ellen Wagner, LCSW
• David K. Wagner, M.D.
• James Allen Wagner, MS
• John Michael Wagner
• Katherine Teresa Wagner, CRNA
• Kevin Wagner, MSPT
• Kirsten U Wagner, FNP
• Kirstin Lynette Wagner, PA-C
• Laurent Wagner, RN

• Pediatric Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.