Active NPI
Dennis L Wagner, MD
- Pain Medicine Physician
- Indianapolis, IN
National Provider Identifier
1891750501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- 01027891
- Practice address
- 1120 South Dr # Fh204
Indianapolis, IN 46202-5135 - Phone
- (317) 944-2891
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 01027891 | IN | |
| Anesthesiology Physician | 207L00000X | 01027891A | IN | |
| Pain Medicine Physician | 208VP0000X | 01027891 | IN | Primary |
Addresses
Primary practice location
1120 South Dr # Fh204
Indianapolis, IN 46202-5135
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100324970 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | DWAGNER@direct.iuhealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01027891 | IN | MD | Pain Medicine Physician |
Interoperability endpoints
- dwagner@direct.iuhealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606089600000",
"number": "1891750501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 SOUTH DR # FH204",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025135",
"telephone_number": "317-944-2891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DENNIS",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2020-11-23",
"certification_date": "2020-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "IN",
"license": "01027891",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IN",
"license": "01027891A",
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "IN",
"license": "01027891",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100324970",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "DWAGNER@direct.iuhealth.org",
"affiliation": "N",
"address_1": "1120 South Dr # Fh204",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462025135",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.