Jerad Scott Wagner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2197 Issued in OK

Practice address

921 14TH Ave NW
Ardmore, OK 73401-1837

Phone

(580) 223-5311

Fax

(580) 223-8227

NPI assigned

Feb 5, 2013

Last updated

Jan 27, 2016By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Physician Assistant

Education

University of Oklahoma College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ideal Home Care, L.P. Home health agency, Ardmore, OK, CCN 377678
• Mays Housecall Home Health of Durant Home health agency, Durant, OK, CCN 377748
• Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047
• Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwagner726674@directc.mercy.net

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment Care Compare group
• Mercy Hospital Healdton, Inc

  • Critical Access Hospital
  • Healdton, OK
  • NPI 1568615656
  Medicare reassignment NPD
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

• Health Watch Health Care of Weatherford, LLC

  dba Mays Housecall Home Health of Durant

  • Home Health Agency
  • Durant, OK
  • NPI 1720480932
  Care Compare affiliation
• Ideal Home Care, LLC

  • Home Health Agency
  • Ardmore, OK
  • NPI 1467430595
  Care Compare affiliation
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635
  Care Compare affiliation
• Mercy Hospital Oklahoma City, Inc

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1184721722
  Care Compare affiliation

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453852800000",
    "number": "1932448347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011837",
            "telephone_number": "580-223-5311",
            "fax_number": "580-223-8227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011837",
            "telephone_number": "580-223-5311",
            "fax_number": "580-223-8227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JERAD",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-05",
        "last_updated": "2016-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "2197",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zyna Ventura
• Virtual Medical Solutions, LLC (Carter County Wound Care)
• Kristal Lynn Voloshin
• W M Parker,PC (william parker,md or mary r parker,md)
• Ivy Charlotte Wade
• Margurite Oree Wagner
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0129)
• Walgreen Co (Walgreens #05739)
• Anna Jolene Walker, ARNP
• Brianna Walker

• Physician Assistant in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.
• 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.