Jeffrey M Wagner, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

MD16033 Issued in SC

Practice address

98 Willow LN
Spartanburg, SC 29307-1357

Phone

(864) 585-5552

Fax

(864) 597-0179

NPI assigned

Oct 26, 2005

Last updated

Oct 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1881684207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603725",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603725",
            "telephone_number": "828-575-2625",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 WILLOW LN",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071357",
            "telephone_number": "864-585-5552",
            "fax_number": "864-597-0179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "SC",
            "license": "16033",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "SC",
            "license": "MD16033",
            "primary": true
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NC",
            "license": "35781",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235321233",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "E593334292",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160337",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "2174958B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly Wade, MMFT, LMFT
• Sara Katherine Wade, LMFT-A
• Thomas Wager II, PT, DPT
• Brian Wagner
• Chad Richard Wagner, D.C.
• Kayce Leah Wagner, MS, ATC
• Lindsay Anne Wagner, RN
• Katelyn Wagoner
• Daniel Lee Wagstaff, M.D.
• Rebecca Leigh Wagstaff, M.D.

• Allergy & Immunology Physician in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Allergy & Immunology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.