Jean Evelyn Vogel Wagner, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036105844 Issued in IL

Practice address

1230 George E Chance Parkway
Caseyville, IL 62232

Phone

(618) 345-5437

Fax

(618) 344-9246

NPI assigned

Sep 6, 2006

Last updated

Dec 5, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jean Evelyn Vogel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jeanwagner@atoz.directglo.com

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.

• A to Z Pediatrics, LLP

  • Pediatrics Physician
  • Caseyville, IL
  • NPI 1053577387
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354665600000",
    "number": "1902909153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 GEORGE E CHANCE PARKWAY",
            "city": "CASEYVILLE",
            "state": "IL",
            "postal_code": "62232",
            "telephone_number": "618-345-5437",
            "fax_number": "618-344-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 GEORGE E CHANCE PARKWAY",
            "city": "CASEYVILLE",
            "state": "IL",
            "postal_code": "62232",
            "telephone_number": "618-345-5437",
            "fax_number": "618-344-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JEAN",
        "middle_name": "EVELYN VOGEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2012-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036105844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105844",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEAN",
            "last_name": "VOGEL",
            "middle_name": "EVELYN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel L Rau, CLC
• Zachary W Runk
• Sarah Ruth Russell, LPTA
• Tomika L Shorter, LPC
• St Clair Supportive Living LP (Knollwood Retirement Community)
• Ellen Marie Warner
• Tamra Anita Watts, SLP
• Rebekah T Woods

• Pediatrics Physician in Caseyville, IL
• Providers in Caseyville, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.