Individual provider Active NPI

Heather N Wagner, PA-C

  • Physician Assistant
  • Allen Park, MI
National Provider Identifier
1902493844
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8020 Winona Ave
Allen Park, MI 48101-2228
Phone
(313) 806-6585
NPI assigned
Dec 27, 2020
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

8020 Winona Ave
Allen Park, MI 48101-2228

Mailing address

8020 Winona Ave
Allen Park, MI 48101-2228
Phone (313) 806-6585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211014000673 MI Practitioner - Physician Assistant 1951709450 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet Urgent Care of MichiganGroup PAC ID 6305188491, 129 clinicians

Practice addresses (Care Compare)

15606 Southfield Rd
Allen Park, MI 48101-2513
Phone (313) 771-5274

16525 Fort St
Southgate, MI 48195-1403
Phone (734) 250-9529

18930 W Rd
Beaumont Urgent Care of Michigan
Woodhaven, MI 48183-3317
Phone (734) 671-4900

19760 Haggerty Rd
Beaumont Urgent Care of Michigan
Livonia, MI 48152-1080
Phone (734) 793-8769

2078 E Big Beaver Rd
Beaumont Urgent Care of Michigan
Troy, MI 48083-2301
Phone (248) 918-0744

23100 Michigan Ave
Dearborn, MI 48124-2033
Phone (313) 263-7584

34435 Michigan Ave
Wayne, MI 48184-1763
Phone (734) 589-1524

42757 Woodward Ave
Beaumont Urgent Care by Wellstreet
Bloomfield Hills, MI 48304-5037
Phone (248) 940-4937

43535 Grand River Ave
Novi, MI 48375-1108
Phone (248) 946-4500

6200 Middlebelt Rd
Garden City, MI 48135-2409
Phone (734) 367-9100

9870 Telegraph Rd
Taylor, MI 48180-3399
Phone (313) 291-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet Urgent Care of Michigan PastSince Aug 6, 2023 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1609027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1902493844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8020 WINONA AVE",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481012228",
            "telephone_number": "313-806-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8020 WINONA AVE",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481012228",
            "telephone_number": "313-806-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "HEATHER",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-27",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allen Park, MI

Sources for this page

Verify at the official NPI Registry.